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General NPI Number Information
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NPI Number | 1083707822
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Entity Type | Organization
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Legal Business Name | VITREO-RETINAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 3555 DEER PARK DR SUITE 180
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City | STOCKTON
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State | CA
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Zip | 95219-2377
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Country | US
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Telephone | 209-938-0496
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Fax | 209-951-5231
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Provider Business Mailing Address
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Address Line | 3 PARK CENTER DR STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95825-8340
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Country | US
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Telephone | 916-514-5469
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL PEARLMAN
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Credential | MD
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Telephone | 916-596-2027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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