NPIMap

Organization Active NPI

Vista Center for the Blind and Visually Impaired

  • Low Vision Rehabilitation Optometrist
  • Santa Cruz, CA
National Provider Identifier
1255388765
Registry record updated Dec 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X
License
220000439 Issued in CA
Legal business name
VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Practice address
3315 Mission Dr Ste B
Santa Cruz, CA 95065
Phone
(831) 458-9766
Fax
(831) 426-6233
NPI assigned
May 28, 2006
Last updated
Dec 18, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIREDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Karae Lisle
Title
Executive Director
Phone
(650) 858-0202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Low Vision Rehabilitation Optometrist 152WL0500X 220000439 CA Primary

Addresses

Primary practice location

3315 Mission Dr Ste B
Santa Cruz, CA 95065

Mailing address

2500 El Camino Real Ste 100
Palo Alto, CA 94306-1723
Phone (650) 858-0202

Other identifiers 1

IdentifierTypeStateIssuer
CMM70249FMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050308000481 CA Part B Supplier - Clinic/Group Practice 9133173693 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palo Alto, CA; San Jose, CA; Santa Cruz, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Vista Center for the Blind3 organizations share this tax ID, including this one
Part of
Vista Center for the Blind

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

413 Laurel St
Santa Cruz, CA 95060
Phone (408) 458-9766

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1255388765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 EL CAMINO REAL STE 100",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061723",
            "telephone_number": "650-858-0202",
            "fax_number": "650-858-0214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 MISSION DR STE B",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "95065",
            "telephone_number": "831-458-9766",
            "fax_number": "831-426-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED",
        "enumeration_date": "2006-05-28",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "LISLE",
        "authorized_official_first_name": "KARAE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "650-858-0202",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "220000439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70249F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; 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.

Verify at the official NPI Registry.