Organization
VISTAR EYE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI E RUNYON (MANAGED CARE COORDINATOR)
(540) 855-5139
Entity
Organization
Contact information
Practice address
707 S JEFFERSON ST, ROANOKE, VA 24016-5100
(540) 344-4000
Mailing address
PO BOX 1789, ROANOKE, VA 24008-1789
(540) 344-4000
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0796160001
DEMERC SUPPLIER NUMBER
VA
Enumeration date
08/04/2006
Last updated
08/22/2020
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