NPIMap

Organization Active NPI

Vistar Eye Center, Inc

  • Eyewear Supplier
  • Roanoke, VA
National Provider Identifier
1265128037
Registry record updated Apr 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
VISTAR EYE CENTER, INC
Practice address
6125 Airport Rd
Roanoke, VA 24019-3813
Phone
(540) 855-5100
NPI assigned
Apr 14, 2023
Last updated
Apr 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2023

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

Authorized official

Name
Staci E Runyon
Title
Managed Care Coordinator
Phone
(540) 855-3554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU Primary

Addresses

Primary practice location

6125 Airport Rd
Roanoke, VA 24019-3813

Mailing address

PO Box 1789
Roanoke, VA 24008-1789
Phone (540) 855-3554

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241105000754 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).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2341588Vistar Eye Center6125 Airport Rd, Roanoke, VA 24019Certificate of waiverApr 5, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Vistar Eye Center Inc6125 Airport Rd, Roanoke, VA 24019-3813(540) 855-5100 Prosthetic Lenses: Conventional Eyeglasses Accepts assignmentParticipating since Apr 1, 1988

National Provider Directory

National Provider Directory
Tax ID family
Vistar Eye Center Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

2617 Sheffield Dr
#B
Blacksburg, VA 24060

1566 N Franklin St
Christiansburg, VA 24073
Phone (540) 381-9086

723 Piney Forest Rd
Ste 101
Danville, VA 24540

1022 E Stuart Dr
Galax, VA 24333
Phone (276) 236-4122

1102 E Stuart Dr
Galax, VA 24333
Phone (276) 236-4171

800 E Stuart Dr
Galax, VA 24333
Phone (276) 236-4171

280 Westlake Rd
Hardy, VA 24101

280 Westlake Rd
Bldg 2
Hardy, VA 24101
Phone (540) 346-2102

1049 Brookdale St
Ste C
Martinsville, VA 24112
Phone (276) 656-2021

749 E Church St
Martinsville, VA 24112
Phone (276) 632-7205

1138 2nd St SW
Roanoke, VA 24016
Phone (540) 345-0486

600 S Pollard St
Vinton, VA 24179
Phone (540) 343-2197

275 W Ridge Rd
Wytheville, VA 24382
Phone (276) 223-0242

310 E Main St
Wytheville, VA 24382
Phone (276) 228-2771

590 W Ridge Rd
Ste B
Wytheville, VA 24382
Phone (276) 223-1334

3942 Davis Stuart Rd
Ronceverte, WV 24970
Phone (304) 647-3987

Practitioners & affiliated clinicians

Practitioners 55

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.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1265128037",
    "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": "540-855-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6125 AIRPORT RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240193813",
            "telephone_number": "540-855-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTAR EYE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "RUNYON",
        "authorized_official_first_name": "STACI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGED CARE COORDINATOR",
        "authorized_official_telephone_number": "540-855-3554"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "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 Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.