Provider Demographics
NPI:1215027859
Name:VISTA CARE PSC
Entity Type:Organization
Organization Name:VISTA CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-995-2450
Mailing Address - Street 1:P60 AVE SANTA JUANITA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4954
Mailing Address - Country:US
Mailing Address - Phone:787-995-2450
Mailing Address - Fax:787-787-2424
Practice Address - Street 1:P60 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4954
Practice Address - Country:US
Practice Address - Phone:787-995-2450
Practice Address - Fax:787-787-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR542261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4871890001OtherPALMETTO
PR601012OtherMMM
PR=========OtherCOSVI
PR=========OtherMAPFRE
PR4871890001OtherPALMETTO
PR=========OtherMEDICAL CARD SYSTEM