Provider Demographics
NPI:1821230335
Name:ZEITER EYE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ZEITER EYE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
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 1:255 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:
Practice Address - Street 1:4598 S TRACY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8107
Practice Address - Country:US
Practice Address - Phone:209-466-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32328ZMedicare PIN