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General NPI Number Information
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NPI Number | 1821181850
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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 | 04/04/2008
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Provider Practice Location Address
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Address Line | 3939 J ST STE 106
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City | SACRAMENTO
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State | CA
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Zip | 95819-3631
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Country | US
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Telephone | 916-454-4861
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Fax | 916-454-3603
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Provider Business Mailing Address
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Address Line | 3939 J ST STE 104
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City | SACRAMENTO
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State | CA
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Zip | 95819-3631
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Country | US
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Telephone | 916-454-6191
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Fax | 916-454-1036
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. CHRIS MENTINK
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Credential |
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Telephone | 916-453-5450
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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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