Provider Demographics
NPI:1376815605
Name:ZEITER EYE MEDICAL GROUP INC OCULAFACIAL PLASTIC AND RECONSTRUCTIVE SU
Entity Type:Organization
Organization Name:ZEITER EYE MEDICAL GROUP INC OCULAFACIAL PLASTIC AND RECONSTRUCTIVE SU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ZEITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-5566
Mailing Address - Street 1:255 E WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2706
Mailing Address - Country:US
Mailing Address - Phone:209-466-5566
Mailing Address - Fax:209-466-0535
Practice Address - Street 1:1801 E MARCH LN
Practice Address - Street 2:SUITE A160
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6629
Practice Address - Country:US
Practice Address - Phone:209-466-5566
Practice Address - Fax:209-466-0535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZEITER EYE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-02
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY399AMedicare PIN