Provider Demographics
NPI:1508117789
Name:ZEITER EYE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ZEITER EYE MEDICAL GROUP, INC
Other - Org Name:LODI EYE CARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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 1:255 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 1:421 S HAM LN
Practice Address - Street 2:SUITE B
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3523
Practice Address - Country:US
Practice Address - Phone:209-368-5352
Practice Address - Fax:209-368-5355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZEITER EYE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-27
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
CA19590332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY399BMedicare PIN
CA1306460004Medicare NSC