Providers: Join Our Network

We are delighted about your interest in joining our provider network! Please complete the application form below to tell us more about yourself and your practice.

If you are not already an NVA network provider, please fill in the following information and click “submit” to send your application. You can also e-mail us directly at newproviders@e-nva.com. An NVA representative will contact you to discuss the details.

Fields marked with an asterisk (*) are required.

License Type*:

Ophthalmologist

Optometrist

Optician

Provider Last Name*:

Provider First Name*:

CAQH #*: (8 Digits)

NPI #*: (10 Digits)

State License #*:

Corporation Name:

Tax ID*: (9 Digits)

Do you provide in-person examinations?*

Yes

Practice Address*:

City*:

County:

State*:

ZIP Code*: (#####)

Contact Phone #*: (###-###-####)

Contact E-mail Address*: (ab@xyz.com)

Are you currently a Medicaid Provider?*

Yes

Are you currently a Medicare Provider?*

Yes

You will be notified by e-mail once your application is reviewed. If accepted, you will be required to complete a W9 Form, NVA Participating Provider Agreement and the NVA Frames Inventory Form, if applicable, and provide your CAQH #, if not already provided, so we may access your credentialing information. If you’re applying via CAQH, please ensure that you grant NVA access to your CAQH record. NVA’s credentialing policy requires providers to be in CAQH. If you are not participating with CAQH, you may go to the CAQH website to complete an application.

Please note that telehealth-only providers will not be accepted.

96%

In-Network Utilization

24/7/365

Live Customer Service
Based in U.S.

99%

Member Satisfaction