Provider Demographics
NPI:1609092337
Name:VISTA VISION EYECARE 2, INC.
Entity Type:Organization
Organization Name:VISTA VISION EYECARE 2, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:DE LA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-804-0476
Mailing Address - Street 1:13625 EAGLE RIDGE DR APT 334
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1882
Mailing Address - Country:US
Mailing Address - Phone:305-804-0476
Mailing Address - Fax:239-265-3218
Practice Address - Street 1:9918 GULF COAST MAIN
Practice Address - Street 2:SUITE B100
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913
Practice Address - Country:US
Practice Address - Phone:239-482-6745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407956048OtherNPI