Provider Demographics
NPI:1891439691
Name:SUPERVISTA NORTH AMERICA
Entity Type:Organization
Organization Name:SUPERVISTA NORTH AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO NORTH AMERICA
Authorized Official - Prefix:
Authorized Official - First Name:YAIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-441-4021
Mailing Address - Street 1:16 TECHNOLOGY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2325
Mailing Address - Country:US
Mailing Address - Phone:949-441-4021
Mailing Address - Fax:
Practice Address - Street 1:3971 IRVINE BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602
Practice Address - Country:US
Practice Address - Phone:949-880-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERVISTA NORTH AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier