Healthcare Provider Details

I. General information

NPI: 1295979672
Provider Name (Legal Business Name): VISTAR EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 FRANKLIN RD SW
ROANOKE VA
24014-1310
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 Code332H00000X
TaxonomyEyewear Supplier
License Number105614
License Number StateVA

VIII. Authorized Official

Name: MR. HERBURT PIERCE
Title or Position: CEO
Credential:
Phone: 540-855-3554