Organization
VISTA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KARAE LISLE (EXECUTIVE DIRECTOR)
(650) 858-0202
Entity
Organization
Contact information
Practice address
2500 EL CAMINO REAL STE 100, PALO ALTO, CA 94306
(650) 858-0202
(650) 858-0214
Mailing address
2500 EL CAMINO REAL STE 100, PALO ALTO, CA 94306-1723
(650) 858-0202
(650) 858-0214
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
220000439
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70427F
—
CA
Enumeration date
05/28/2006
Last updated
12/18/2018
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