Vistec LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-0721 Issued in ID

Legal business name

VISTEC LLC

Practice address

1246 Yellowstone Ave Ste A4
Pocatello, ID 83201-4372

Phone

(208) 237-7666

NPI assigned

Mar 5, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Wallace L Christensen, O.D.NPI 1760435143

Title

Owner/Optometrist

Phone

(208) 237-7666

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wallace L Christensensen, OD Former legal business name

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

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

• Wallace Lloyd Christensen, OD

  • Optometrist
  • Pocatello, ID
  • NPI 1760435143
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1992198675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 YELLOWSTONE AVE STE A4",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014372",
            "telephone_number": "208-237-7666",
            "fax_number": "208-237-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 YELLOWSTONE AVE STE A4",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014372",
            "telephone_number": "208-237-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTEC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-05",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "208-237-7666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-0721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002875500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallace L Christensensen, OD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Deborah Michelle Vieira, M.S., CCC-A
• Peter Vik, PH.D.
• Supriya Vikranth
• Andrew Lee Vincent, D.O.
• Alisa Vineyard, AU.D.
• Sandra Lyn Vollmer, LMSW
• James Vonbusch, LPC
• Conner James Vrba, LPC, NCC
• Cindy Wade, LCPC
• Laura Ann Wadsworth Lundquist, MSN, FNP-C, IBCLC

• Optometrist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; 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.