Provider Demographics
NPI:1740437920
Name:VITREO-RETINAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:VITREO-RETINAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-596-2027
Mailing Address - Street 1:3 PARK CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8341
Mailing Address - Country:US
Mailing Address - Phone:916-596-2027
Mailing Address - Fax:866-913-6557
Practice Address - Street 1:9381 E STOCKTON BLVD
Practice Address - Street 2:STE 106
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5068
Practice Address - Country:US
Practice Address - Phone:916-714-5500
Practice Address - Fax:916-454-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07580ZMedicare PIN