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NPI Code Detail

MEDICARE: VISTAR EYE CENTER

MEDICARE: VISTAR EYE CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier3699VA

General Provider Information

NPI Number : 1003050485
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTAR EYE CENTER
Provider Business Mailing Address
First Line : PO BOX 1789
Second Line :
City : ROANOKE
State : VA
Zip : 24008-1789
Country : US
Telephone Number : 540-855-5139
Fax Number : 540-342-4373
Provider Business Practice Location Address
First Line : 70 SUMMERFIELD CT
Second Line :
City : ROANOKE
State : VA
Zip : 24019-4579
Country : US
Telephone Number : 540-855-5139
Fax Number : 540-342-4373
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. KATHY P COWAN
Credential :
Telephone Number : 540-855-5123
Provider Enumeration Date : 04/29/2009
Last Update Date : 07/23/2009

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Directions to “VISTAR EYE CENTER ” Practice Location

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