MEDICARE: NOVA EYEWEAR LLC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1831958941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA EYEWEAR LLC

Provider Business Mailing Address
First Line	:	4832 CLEARVIEW EXPY
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1040
Country	:	US
Telephone Number	:	917-378-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	4832 CLEARVIEW EXPY
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1040
Country	:	US
Telephone Number	:	917-378-2728
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEEKYOUNG KIM
Credential	:
Telephone Number	:	917-378-2728

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	03/19/2024

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