Provider Demographics
NPI:1164524252
Name:VISTA IMAGING SERVICES, INC
Entity Type:Organization
Organization Name:VISTA IMAGING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:415-272-3925
Mailing Address - Street 1:8 LILAC PL
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-7215
Mailing Address - Country:US
Mailing Address - Phone:415-272-3925
Mailing Address - Fax:415-704-3284
Practice Address - Street 1:8 LILAC PL
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-7215
Practice Address - Country:US
Practice Address - Phone:415-272-3925
Practice Address - Fax:415-704-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF75579247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31881ZMedicare ID - Type UnspecifiedIDTF
CAZZZ31892ZMedicare ID - Type UnspecifiedIDTF