Healthcare Provider Details

I. General information

NPI: 1447804844
Provider Name (Legal Business Name): VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 EL CAMINO REAL STE 100
PALO ALTO CA
94306-1723
US

IV. Provider business mailing address

2500 EL CAMINO REAL STE 100
PALO ALTO CA
94306-1723
US

V. Phone/Fax

Practice location:
  • Phone: 408-295-4016
  • Fax: 408-295-1398
Mailing address:
  • Phone: 650-858-0202
  • Fax: 650-858-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MONICA MAEZ
Title or Position: PATIENT CARE COORDINATOR
Credential:
Phone: 831-458-9766