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General NPI Number Information
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NPI Number | 1780701193
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Entity Type | Organization
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Legal Business Name | VISTA OPTOMETRIC CENTER
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 217 ESCONDIDO AVE STE 1
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City | VISTA
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State | CA
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Zip | 92084-6170
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Country | US
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Telephone | 760-630-2020
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Fax | 760-630-2020
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Provider Business Mailing Address
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Address Line | 217 ESCONDIDO AVE #1
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City | VISTA
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State | CA
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Zip | 92084-6170
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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 | PROPRIETOR
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Name | DR. OSCAR CHUNG
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Credential | O.D.
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Telephone | 760-630-2020
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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 | OP6186T
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License Number State | CA
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