Provider Demographics
NPI:1669969960
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:
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:
Practice Address - Street 1:1680 E ROSEVILLE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3988
Practice Address - Country:US
Practice Address - Phone:916-774-0100
Practice Address - Fax:916-774-0151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITREO-RETINAL MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty