MEDICARE: NOVA EYE MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101241432	VA

General Provider Information

NPI Number	:	1598911406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA EYE MD, INC.

Provider Business Mailing Address
First Line	:	5900 FORT DR
Second Line	:	SUITE 207
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-2425
Country	:	US
Telephone Number	:	703-263-3147
Fax Number	:	703-263-3148

Provider Business Practice Location Address
First Line	:	5900 FORT DR
Second Line	:	SUITE 207
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-2425
Country	:	US
Telephone Number	:	703-263-3147
Fax Number	:	703-263-3148

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. NISHA RAMAN PATEL
Credential	:	MD
Telephone Number	:	703-263-3147

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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