Healthcare Provider Details

I. General information

NPI: 1508707324
Provider Name (Legal Business Name): VITREORETINAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 N LINDEN DR STE 231
BEVERLY HILLS CA
90212-2264
US

IV. Provider business mailing address

462 N LINDEN DR STE 231
BEVERLY HILLS CA
90212-2264
US

V. Phone/Fax

Practice location:
  • Phone: 310-734-7611
  • Fax: 310-957-9422
Mailing address:
  • Phone: 310-734-7611
  • Fax: 310-957-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JAVAHERI
Title or Position: PRESIDENT
Credential: MD
Phone: 310-734-7611