Provider Demographics
NPI:1609809144
Name:MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONHAM-STEFFENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-731-5955
Mailing Address - Street 1:1700 ALHAMBRA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7050
Mailing Address - Country:US
Mailing Address - Phone:916-731-8040
Mailing Address - Fax:916-454-4152
Practice Address - Street 1:1830 SIERRA GARDENS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2942
Practice Address - Country:US
Practice Address - Phone:916-782-2111
Practice Address - Fax:916-786-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042242Medicaid
CAGR0042242Medicaid
CAZZZ39906ZMedicare PIN