Provider Demographics
NPI:1952045759
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 1:9301 TAMPA AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91324-9132
Practice Address - Country:US
Practice Address - Phone:213-995-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERVISTA NORTH AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier