Healthcare Provider Details

I. General information

NPI: 1144410705
Provider Name (Legal Business Name): ZEITER EYE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN SUITE C350
STOCKTON CA
95210-6629
US

IV. Provider business mailing address

255 E WEBER AVE
STOCKTON CA
95202-2706
US

V. Phone/Fax

Practice location:
  • Phone: 209-951-1178
  • Fax:
Mailing address:
  • Phone: 209-466-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN HENRY ZEITER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-466-5566