Provider Demographics
NPI:1841633831
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 COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:E
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:540-855-3554
Mailing Address - Fax:540-342-4373
Practice Address - Street 1:280 WESTLAKE RD
Practice Address - Street 2:PROFESSIONAL PARK BUILDING#2
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3967
Practice Address - Country:US
Practice Address - Phone:540-346-2102
Practice Address - Fax:540-346-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0796160007Medicare NSC