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General NPI Number Information
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NPI Number | 1871101576
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Entity Type | Organization
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Legal Business Name | VISTA EYECARE, LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 3018 EAST AVE
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City | CENTRAL SQUARE
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State | NY
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Zip | 13036-2713
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Country | US
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Telephone | 315-885-0764
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Fax |
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Provider Business Mailing Address
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Address Line | 8494 VAN WIE DR W
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-8935
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Country | US
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Telephone | 315-885-0764
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DAVID BRIAN TORRALES
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Credential | OD
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Telephone | 315-885-0764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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