Provider Demographics
NPI:1578823837
Name:VISTA VISION FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:VISTA VISION FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:LISENBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-249-2330
Mailing Address - Street 1:2770 WOODGATE RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5466
Mailing Address - Country:US
Mailing Address - Phone:970-249-2330
Mailing Address - Fax:970-249-6131
Practice Address - Street 1:2545 RIMROCK AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8664
Practice Address - Country:US
Practice Address - Phone:970-242-9050
Practice Address - Fax:970-242-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty