Healthcare Provider Details

I. General information

NPI: 1831122308
Provider Name (Legal Business Name): MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 BELL RD
AUBURN CA
95603-9243
US

IV. Provider business mailing address

1700 ALHAMBRA BLVD SUITE 202
SACRAMENTO CA
95816-7050
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-8835
  • Fax: 530-886-8853
Mailing address:
  • Phone: 916-731-8040
  • Fax: 916-454-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE GABELICH
Title or Position: COO
Credential:
Phone: 916-731-8040