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General NPI Number Information
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NPI Number | 1326880642
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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 | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 615 INTERNATIONAL PKWY STE 103
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City | TRACY
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State | CA
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Zip | 95377-8922
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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 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 | 916-514-5469
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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 | 916-514-5469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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