Provider Demographics
NPI:1851482970
Name:VISTA OPHTHALMOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:VISTA OPHTHALMOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHAV
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-618-3937
Mailing Address - Street 1:1255 CORPORATE DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2518
Mailing Address - Country:US
Mailing Address - Phone:972-791-1224
Mailing Address - Fax:877-594-5434
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:SUITE 860
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:214-618-3937
Practice Address - Fax:214-618-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00790UMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER