MEDICARE: VITREO-RETINAL MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician

General Provider Information

NPI Number	:	1144733403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITREO-RETINAL MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	3 PARK CENTER DR STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-8340
Country	:	US
Telephone Number	:	916-596-2027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 LASSEN BLVD STE B
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-9455
Country	:	US
Telephone Number	:	530-923-7973
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL PEARLMAN
Credential	:	M.D.
Telephone Number	:	916-596-2027

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	10/06/2023

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