Provider Demographics
NPI:1609997972
Name:VISTA OPTICAL
Entity Type:Organization
Organization Name:VISTA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-266-7603
Mailing Address - Street 1:2333 N TRIPHAMMER RD STE 403
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1075
Mailing Address - Country:US
Mailing Address - Phone:607-266-7603
Mailing Address - Fax:607-266-7601
Practice Address - Street 1:2333 N TRIPHAMMER RD STE 403
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1075
Practice Address - Country:US
Practice Address - Phone:607-266-7603
Practice Address - Fax:607-266-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Single Specialty