Provider Demographics
NPI:1295702918
Name:NEW VISTA EYECARE CORP
Entity type:Organization
Organization Name:NEW VISTA EYECARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-726-9077
Mailing Address - Street 1:331 E PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3463
Mailing Address - Country:US
Mailing Address - Phone:715-726-9077
Mailing Address - Fax:715-726-9173
Practice Address - Street 1:331 E PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3463
Practice Address - Country:US
Practice Address - Phone:715-726-9077
Practice Address - Fax:715-726-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1288152W00000X
WI1359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38445000Medicaid
WI0411330001Medicare NSC
WI000083676Medicare ID - Type Unspecified