Provider Demographics
NPI:1275608218
Name:ZEITER EYE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ZEITER EYE MEDICAL GROUP, INC.
Other - Org Name:AMBULATORY SURGICAL CENTER OF ZEITER EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZEITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-5566
Mailing Address - Street 1:117 N SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2406
Mailing Address - Country:US
Mailing Address - Phone:209-466-5566
Mailing Address - Fax:209-464-6950
Practice Address - Street 1:117 N SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2406
Practice Address - Country:US
Practice Address - Phone:209-466-5566
Practice Address - Fax:209-464-6950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000483261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15078ZOtherMEDICARE PTAN
CASUR01089FMedicaid