1902212772 NPI number — VISTA POINT EYE CARE

Table of content: (NPI 1902212772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902212772 NPI number — VISTA POINT EYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA POINT EYE CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902212772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 PLEASANT GROVE BLVD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95678-7215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-797-3937
Provider Business Mailing Address Fax Number:
916-797-3944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 DOUGLAS BLVD
Provider Second Line Business Practice Location Address:
SUITE C-4
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-797-3937
Provider Business Practice Location Address Fax Number:
916-797-3944
Provider Enumeration Date:
07/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BARBER
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-797-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  11858 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com