Provider Demographics
NPI:1184140618
Name:VISTAR EYE CENTER, INC
Entity type:Organization
Organization Name:VISTAR EYE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-855-3554
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24008-1789
Mailing Address - Country:US
Mailing Address - Phone:276-632-7205
Mailing Address - Fax:276-632-6366
Practice Address - Street 1:749 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3106
Practice Address - Country:US
Practice Address - Phone:276-632-7205
Practice Address - Fax:276-632-6366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTAR EYE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001837152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty