Provider Demographics
NPI:1578052791
Name:VISTASITE OPTIQUE INC
Entity Type:Organization
Organization Name:VISTASITE OPTIQUE INC
Other - Org Name:VISTASITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-433-0136
Mailing Address - Street 1:4204 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3706
Mailing Address - Country:US
Mailing Address - Phone:917-261-6100
Mailing Address - Fax:917-861-6697
Practice Address - Street 1:4204 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3706
Practice Address - Country:US
Practice Address - Phone:917-261-6100
Practice Address - Fax:917-861-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery