Healthcare Provider Details

I. General information

NPI: 1295407328
Provider Name (Legal Business Name): VISTA EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 MISSOURI AVE
LAS CRUCES NM
88001-5109
US

IV. Provider business mailing address

2448 MISSOURI AVE
LAS CRUCES NM
88001-5109
US

V. Phone/Fax

Practice location:
  • Phone: 719-214-6570
  • Fax:
Mailing address:
  • Phone: 575-521-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CARLA A WENDLER
Title or Position: OWNER
Credential: OD
Phone: 575-521-1050