Provider Demographics
NPI:1669130332
Name:VISTA OPTICA LLC
Entity type:Organization
Organization Name:VISTA OPTICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPMETRY DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:939-303-3046
Mailing Address - Street 1:SUNRISE 29
Mailing Address - Street 2:SUNSET ST
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-922-5847
Mailing Address - Fax:
Practice Address - Street 1:AVE PADRE RIVERA #15
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:939-303-3046
Practice Address - Fax:939-303-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty