Healthcare Provider Details

I. General information

NPI: 1720011158
Provider Name (Legal Business Name): MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120A W COURT ST
WOODLAND CA
95695-2901
US

IV. Provider business mailing address

1700 ALHAMBRA BLVD SUITE 202
SACRAMENTO CA
95816-7050
US

V. Phone/Fax

Practice location:
  • Phone: 530-668-6000
  • Fax: 530-668-9560
Mailing address:
  • Phone: 916-731-8040
  • Fax: 916-454-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOANN MUSHOLT
Title or Position: BILLING MGR
Credential:
Phone: 916-731-5955