MEDICARE: CENTRAL VALLEY EYE 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	152W00000X	Optometrist		CA
2	207W00000X	Ophthalmology Physician		CA

General Provider Information

NPI Number	:	1609975366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VALLEY EYE MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	36 WEST YOKUTS AVE
Second Line	:	SUITE 1
City	:	STOCKTON
State	:	CA
Zip	:	95207-5713
Country	:	US
Telephone Number	:	209-952-3700
Fax Number	:	209-478-3302

Provider Business Practice Location Address
First Line	:	36 WEST YOKUTS AVE
Second Line	:	SUITE 1
City	:	STOCKTON
State	:	CA
Zip	:	95207-5713
Country	:	US
Telephone Number	:	209-952-3700
Fax Number	:	209-478-3302

Authorized Official
Title or Position	:	CFO
Name	:	STEVENS Y. KIM
Credential	:	MD
Telephone Number	:	209-952-3700

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/02/2013

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