MEDICARE: VITREO-RETINAL ASSOCIATES MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180003746	OTHER	CA	MEDICARE RAILROAD
2	CS9651	OTHER	CA	MEDICARE RAILROAD
4	W11190	OTHER	CA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245269356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITREO-RETINAL ASSOCIATES MEDICAL GROUP

Provider Business Mailing Address
First Line	:	800 FAIRMOUNT AVE STE 120
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3151
Country	:	US
Telephone Number	:	626-440-9920
Fax Number	:	626-440-0351

Provider Business Practice Location Address
First Line	:	800 FAIRMOUNT AVE STE 120
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3151
Country	:	US
Telephone Number	:	626-440-9920
Fax Number	:	626-440-0351

Authorized Official
Title or Position	:	PARTNERSHIP
Name	:	LAWRENCE JOSEPH KONDRA
Credential	:	MD
Telephone Number	:	626-440-9920

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	01/02/2018

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Directions to “VITREO-RETINAL ASSOCIATES MEDICAL GROUP ” Practice Location

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