Healthcare Provider Details

I. General information

NPI: 1013940519
Provider Name (Legal Business Name): MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ALHAMBRA BLVD SUITE 202
SACRAMENTO CA
95816-7050
US

IV. Provider business mailing address

1700 ALHAMBRA BLVD SUITE 202
SACRAMENTO CA
95816-7050
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-8040
  • Fax: 916-454-4152
Mailing address:
  • Phone: 916-731-8040
  • Fax: 916-454-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAURA LYNN STONHAM
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 916-731-5955