Provider Demographics
NPI:1538213400
Name:VISTA VISION & CONTACT LENS CENTER LLC
Entity type:Organization
Organization Name:VISTA VISION & CONTACT LENS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUJAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-263-8956
Mailing Address - Street 1:2801 GRAND AVE STE 73
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4652
Mailing Address - Country:US
Mailing Address - Phone:515-233-5664
Mailing Address - Fax:515-233-6272
Practice Address - Street 1:2801 GRAND AVE STE 73
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4652
Practice Address - Country:US
Practice Address - Phone:515-233-5664
Practice Address - Fax:515-233-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27332OtherAVESIS
IA28245OtherSPECTERA
IA27332OtherAVESIS