Provider Demographics
NPI:1659082436
Name:VISTA FAMILY EYE CARE, PLLC
Entity Type:Organization
Organization Name:VISTA FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FCOVD
Authorized Official - Phone:737-707-2155
Mailing Address - Street 1:109 CORTONA LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7073
Mailing Address - Country:US
Mailing Address - Phone:512-297-1158
Mailing Address - Fax:
Practice Address - Street 1:14125 W STATE HIGHWAY 29 STE B202
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-2207
Practice Address - Country:US
Practice Address - Phone:737-707-2155
Practice Address - Fax:737-707-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty