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General NPI Number Information
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NPI Number | 1841633831
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Entity Type | Organization
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Legal Business Name | VISTAR EYE CENTER, INC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 280 WESTLAKE RD PROFESSIONAL PARK BUILDING#2
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City | HARDY
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State | VA
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Zip | 24101-3967
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Country | US
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Telephone | 540-346-2102
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Fax | 540-346-2109
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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 | 540-855-3554
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Fax | 540-342-4373
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Authorized Official
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Title or Position | MANAGED CARE COORDINATOR
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Name | STACI E RUNYON
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Credential |
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Telephone | 540-855-3554
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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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