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General NPI Number Information
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NPI Number | 1114010949
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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 | 4712 STODDARD RD
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City | MODESTO
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State | CA
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Zip | 95356-9404
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Country | US
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Telephone | 209-549-8444
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Fax | 209-549-8443
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Provider Business Mailing Address
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Address Line | 3 PARK CENTER DR STE 210
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City | SACRAMENTO
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State | CA
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Zip | 95825-8341
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Country | US
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Telephone | 916-596-2027
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Fax | 866-913-6557
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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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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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