Healthcare Provider Details

I. General information

NPI: 1508117789
Provider Name (Legal Business Name): ZEITER EYE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S HAM LN SUITE B
LODI CA
95242-3523
US

IV. Provider business mailing address

255 E WEBER AVE
STOCKTON CA
95202-2706
US

V. Phone/Fax

Practice location:
  • Phone: 209-368-5352
  • Fax: 209-368-5355
Mailing address:
  • Phone: 209-466-5566
  • Fax: 209-466-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number19590
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN H ZEITER
Title or Position: PRESIDENT
Credential: MD
Phone: 209-466-5566