NPIMap

Organization Active NPI

Vistar Eye Center, Inc

  • Eyewear Supplier
  • Roanoke, VA
National Provider Identifier
1326538224
Registry record updated Mar 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
VISTAR EYE CENTER, INC
Practice address
1819 Electric Rd Ste 1a
Roanoke, VA 24018-1618
Phone
(540) 855-5100
NPI assigned
May 16, 2018
Last updated
Mar 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
VISTAR EYE CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2020

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
Phone
(540) 855-3554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

1819 Electric Rd Ste 1a
Roanoke, VA 24018-1618

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
O20181019001698 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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Vistar Pediatric Optical1819 Electric Rd, Roanoke, VA 24018-1605(540) 855-5100 Prosthetic Lenses: Conventional Eyeglasses Accepts assignmentParticipating since Apr 1, 1988

National Provider Directory

National Provider Directory
Tax ID family
M K Humphries III MD9 organizations share this tax ID, including this one
Part of
M K Humphries III MD

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1326538224",
    "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",
            "fax_number": "540-342-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 ELECTRIC RD STE 1A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181618",
            "telephone_number": "540-855-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTAR EYE CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VISTAR EYE CENTER, INC",
        "enumeration_date": "2018-05-16",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "RUNYON",
        "authorized_official_first_name": "STACI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGED CARE",
        "authorized_official_telephone_number": "540-855-3554"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "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 Mar 30, 2020; 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.