Healthcare Provider Details

I. General information

NPI: 1548132285
Provider Name (Legal Business Name): VISTASITE EYE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 W 207TH ST
NEW YORK NY
10034-2607
US

IV. Provider business mailing address

573 W 207TH ST
NEW YORK NY
10034-2607
US

V. Phone/Fax

Practice location:
  • Phone: 212-569-3099
  • Fax: 212-569-3166
Mailing address:
  • Phone: 212-569-3099
  • Fax: 212-569-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSIE ZAPATA
Title or Position: CREDENTIALER
Credential:
Phone: 347-324-4207