Basic Information
| Provider Information | |||||||||
| NPI: | 1851482970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISTA OPHTHALMOLOGY ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 CORPORATE DR | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750382518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727911224 | ||||||||
| FaxNumber: | 8775945434 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 ALLIANCE BLVD | ||||||||
| Address2: | SUITE 860 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146183937 | ||||||||
| FaxNumber: | 2146183984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | RAGHAV | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2146183937 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 208600000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.