MEDICARE: VISTA EYECARE, LLC

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
1	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1871101576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA EYECARE, LLC

Provider Business Mailing Address
First Line	:	8494 VAN WIE DR W
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-8935
Country	:	US
Telephone Number	:	315-885-0764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 EAST AVE
Second Line	:
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036-2713
Country	:	US
Telephone Number	:	315-885-0764
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DAVID BRIAN TORRALES
Credential	:	OD
Telephone Number	:	315-885-0764

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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