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General NPI Number Information
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NPI Number | 1932094828
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Entity Type | Organization
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Legal Business Name | VISTA EYECARE & WELLNESS
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 2310 LONGFIBRE RD
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City | UNION GAP
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State | WA
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Zip | 98903-1513
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Country | US
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Telephone | 509-454-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 LONGFIBRE RD
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City | UNION GAP
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State | WA
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Zip | 98903-1513
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Country | US
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Telephone | 509-454-5253
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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. JACQUELINE CRISTINA GOMEZ
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Credential | OD
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Telephone | 509-454-5253
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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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