Provider Demographics
NPI:1225349673
Name:VISTA EYE EXAM
Entity Type:Organization
Organization Name:VISTA EYE EXAM
Other - Org Name:VISTA EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-525-6881
Mailing Address - Street 1:2232 HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:990 W 41ST ST
Practice Address - Street 2:IRONGATE PLAZA
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3045
Practice Address - Country:US
Practice Address - Phone:218-263-8956
Practice Address - Fax:218-263-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier