Provider Demographics
NPI:1841383882
Name:VITREO-RETINAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:VITREO-RETINAL MEDICAL GROUP, INC.
Other - Org Name:RETINAL CONSULTANTS MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
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 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8340
Mailing Address - Country:US
Mailing Address - Phone:916-596-2027
Mailing Address - Fax:
Practice Address - Street 1:5775 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2013
Practice Address - Country:US
Practice Address - Phone:916-339-3655
Practice Address - Fax:916-339-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
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
CACP5300OtherRAILROAD MEDICARE
CAZZZ14096ZOtherBLUE SHIELD CA
CAZZZ07580ZMedicare PIN