Healthcare Provider Details

I. General information

NPI: 1457323545
Provider Name (Legal Business Name): VISTAR EYE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S JEFFERSON ST
ROANOKE VA
24016-5100
US

IV. Provider business mailing address

PO BOX 1789
ROANOKE VA
24008-1789
US

V. Phone/Fax

Practice location:
  • Phone: 540-855-5139
  • Fax: 540-342-4373
Mailing address:
  • Phone: 540-855-5139
  • Fax: 540-342-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL LEVY
Title or Position: ADMINISTRATOR
Credential:
Phone: 540-855-5123