Providers: Join Our Network

We are delighted about your interest in joining our provider network. Now that you know a little bit about us, tell us about yourself.

If you are not already a provider in our network, please fill in the following information and click “submit” to send the request to join our provider network. 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)

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 request for participation is reviewed. If accepted, you will be required to complete a W9 Form, NVA Contract and Frames Inventory Form, if applicable, and provide your CAQH # so we may access your credentialing information. If you’re applying via CAQH please ensure that you grant NVA access to your CAQH record. If you are not participating with CAQH, you may go to the CAQH website to complete an application.

96%

In-Network Utilization

24/7/365

Live Customer Service
Based in U.S.

99%

Member Satisfaction