Provider Demographics
NPI:1184862963
Name:VISTA EYE CARE, PS
Entity Type:Organization
Organization Name:VISTA EYE CARE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAPHOL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-227-2750
Mailing Address - Street 1:17801 108TH AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6420
Mailing Address - Country:US
Mailing Address - Phone:206-227-2750
Mailing Address - Fax:
Practice Address - Street 1:17801 108TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6420
Practice Address - Country:US
Practice Address - Phone:206-227-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD1898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty