Healthcare Provider Details

I. General information

NPI: 1275608218
Provider Name (Legal Business Name): ZEITER EYE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N SAN JOAQUIN ST
STOCKTON CA
95202-2406
US

IV. Provider business mailing address

117 N SAN JOAQUIN ST
STOCKTON CA
95202-2406
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-5566
  • Fax: 209-464-6950
Mailing address:
  • Phone: 209-466-5566
  • Fax: 209-464-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number030000483
License Number StateCA

VIII. Authorized Official

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