NPIMap

Organization Active NPI

Vista Vision Family Eye Care, LLC

  • Optometrist
  • Grand Junction, CO
National Provider Identifier
1578823837
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2792 Issued in CO
Legal business name
VISTA VISION FAMILY EYE CARE, LLC
Practice address
2545 Rimrock Ave
Grand Junction, CO 81505-8664
Phone
(970) 242-9050
Fax
(970) 242-0448
NPI assigned
May 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

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

Authorized official

Name
Dr. Matthew Jason Lisenby, O.D.NPI 1043516784
Title
Owner
Phone
(970) 249-2330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2792 CO Primary

Addresses

Primary practice location

2545 Rimrock Ave
Grand Junction, CO 81505-8664

Mailing address

2770 Woodgate Rd
Montrose, CO 81401-5466
Phone (970) 249-2330

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120725000773 CO Part B Supplier - Clinic/Group Practice 6103082748 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Junction, CO; Montrose, CO

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 Directory
Tax ID family
Vista Vision Family Eye Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1578823837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 WOODGATE RD",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814015466",
            "telephone_number": "970-249-2330",
            "fax_number": "970-249-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 RIMROCK AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815058664",
            "telephone_number": "970-242-9050",
            "fax_number": "970-242-0448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA VISION FAMILY EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "LISENBY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-249-2330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; 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.