Provider Demographics
NPI:1689897399
Name:VISTA OPTICAL, LLC
Entity Type:Organization
Organization Name:VISTA OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCWHARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-266-7600
Mailing Address - Street 1:2333 N TRIPHAMMER RD
Mailing Address - Street 2:STE 403
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1082
Mailing Address - Country:US
Mailing Address - Phone:607-266-7600
Mailing Address - Fax:607-266-7601
Practice Address - Street 1:2333 N TRIPHAMMER RD
Practice Address - Street 2:STE 403
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1075
Practice Address - Country:US
Practice Address - Phone:607-266-7600
Practice Address - Fax:607-266-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01679547Medicaid
NY5946580001Medicare NSC
NYG28673Medicare UPIN