Active NPI
Vistar Eye Center
- Eyewear Supplier
- Roanoke, VA
National Provider Identifier
1003050485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- License
- 3699
- Legal business name
- VISTAR EYE CENTER
- Practice address
- 70 Summerfield CT
Roanoke, VA 24019-4579 - Phone
- (540) 855-5139
- Fax
- (540) 342-4373
- NPI assigned
- Apr 29, 2009
- Last updated
- Jul 23, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kathy P Cowan
- Title
- Administrator
- Phone
- (540) 855-5123
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | 3699 | VA | Primary |
Addresses
Primary practice location
70 Summerfield CT
Roanoke, VA 24019-4579
Mailing address
PO Box 1789
Roanoke, VA 24008-1789
Phone (540) 855-5139
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930002494 | VA | DME Supplier - Physician - Optometrist | 0446249858 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Roanoke, VA |
| O20100930082508 | VA | DME Supplier - Physician - Optometrist | 0446249858 | Practice locations: Roanoke, VA |
Other NPIs with the same Medicare PAC ID 7
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240963200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1248307200000",
"number": "1003050485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1789",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240081789",
"telephone_number": "540-855-5139",
"fax_number": "540-342-4373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 SUMMERFIELD CT",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240194579",
"telephone_number": "540-855-5139",
"fax_number": "540-342-4373"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VISTAR EYE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2009-04-29",
"last_updated": "2009-07-23",
"status": "A",
"authorized_official_last_name": "COWAN",
"authorized_official_first_name": "KATHY",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "540-855-5123",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "VA",
"license": "3699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.