Provider Demographics
NPI:1447804844
Name:VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Entity Type:Organization
Organization Name:VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Other - Org Name:THE VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-458-9766
Mailing Address - Street 1:2500 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1723
Mailing Address - Country:US
Mailing Address - Phone:650-858-0202
Mailing Address - Fax:650-858-0214
Practice Address - Street 1:2500 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1723
Practice Address - Country:US
Practice Address - Phone:408-295-4016
Practice Address - Fax:408-295-1398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty