Provider Demographics
NPI:1649620337
Name:VISTA CARE OPTICAL LLC
Entity type:Organization
Organization Name:VISTA CARE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-397-3366
Mailing Address - Street 1:P60 AVE SANTA JUANITA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4954
Mailing Address - Country:US
Mailing Address - Phone:787-995-2450
Mailing Address - Fax:787-787-2424
Practice Address - Street 1:P60 AVE SANTA JUANITA
Practice Address - Street 2:URB. SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4954
Practice Address - Country:US
Practice Address - Phone:787-995-2450
Practice Address - Fax:787-787-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier