Provider Demographics
NPI:1336398353
Name:VISTA ALLIANCE EYE CARE
Entity Type:Organization
Organization Name:VISTA ALLIANCE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-627-0303
Mailing Address - Street 1:160 E 56TH ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3609
Mailing Address - Country:US
Mailing Address - Phone:212-758-3838
Mailing Address - Fax:
Practice Address - Street 1:160 E 56TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3609
Practice Address - Country:US
Practice Address - Phone:212-758-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW33501Medicare PIN