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General NPI Number Information
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NPI Number | 1578823837
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Entity Type | Organization
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Legal Business Name | VISTA VISION FAMILY EYE CARE, LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 2545 RIMROCK AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-8664
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Country | US
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Telephone | 970-242-9050
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Fax | 970-242-0448
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Provider Business Mailing Address
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Address Line | 2770 WOODGATE RD
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City | MONTROSE
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State | CO
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Zip | 81401-5466
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Country | US
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Telephone | 970-249-2330
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Fax | 970-249-6131
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW JASON LISENBY
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Credential | O.D.
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Telephone | 970-249-2330
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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 | 2792
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License Number State | CO
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