Provider Demographics
NPI:1225241961
Name:VISTA EYE CARE, PLC
Entity Type:Organization
Organization Name:VISTA EYE CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LYNN CONTRERAS
Authorized Official - Last Name:NOGALES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-625-5673
Mailing Address - Street 1:560 E CONTINENTAL RD
Mailing Address - Street 2:STE 104
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1825
Mailing Address - Country:US
Mailing Address - Phone:520-625-5673
Mailing Address - Fax:520-625-6259
Practice Address - Street 1:560 E CONTINENTAL RD
Practice Address - Street 2:STE 104
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1825
Practice Address - Country:US
Practice Address - Phone:520-625-5673
Practice Address - Fax:520-625-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ976152W00000X
AZ37027207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ115447Medicare PIN