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General NPI Number Information
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NPI Number | 1043354962
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Entity Type | Organization
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Legal Business Name | VISTAR EYE CENTER
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 707 S JEFFERSON ST
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City | ROANOKE
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State | VA
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Zip | 24016-5100
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Country | US
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Telephone | 540-344-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1789
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City | ROANOKE
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State | VA
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Zip | 24008-1789
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATHY P COWAN
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Credential |
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Telephone | 540-855-5139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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