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General NPI Number Information
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NPI Number | 1144878778
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Entity Type | Organization
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Legal Business Name | VISTA ON 3RD INC.
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 2882 3RD AVE
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City | BRONX
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State | NY
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Zip | 10455-2640
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Country | US
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Telephone | 718-585-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 2882 3RD AVE
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City | BRONX
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State | NY
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Zip | 10455-2640
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Country | US
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Telephone | 718-585-1500
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Fax |
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Authorized Official
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Title or Position | DOCTOR/ OWNER
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Name | ROSTISLAV RYVKIN
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Credential | O.D.
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Telephone | 718-585-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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