Healthcare Provider Details

I. General information

NPI: 1104126507
Provider Name (Legal Business Name): ZEITER EYE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940H SYLVA LANE
SONORA CA
95370-5969
US

IV. Provider business mailing address

255 E WEBER AVE
STOCKTON CA
95202-2706
US

V. Phone/Fax

Practice location:
  • Phone: 209-932-4123
  • Fax:
Mailing address:
  • Phone: 209-466-5566
  • Fax: 209-466-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBBIE L STEELE
Title or Position: FINANCIAL SUPERVISOR
Credential:
Phone: 209-466-5566