Healthcare Provider Details

I. General information

NPI: 1376815605
Provider Name (Legal Business Name): ZEITER EYE MEDICAL GROUP INC OCULAFACIAL PLASTIC AND RECONSTRUCTIVE SU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN SUITE A160
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: 209-466-5566
  • Fax: 209-466-0535
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 State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

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