# CAPITAL EYE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568893659
- **Authorized official:** MITRA AYAZIFAR MD (OWNER)
- **Authorized official phone:** (916) 960-9176

## Contact information

- **Practice address:** 817 COURT ST STE 10, JACKSON, CA 95642-2156
- **Practice address phone:** (209) 223-2020
- **Practice address fax:** (209) 223-2046
- **Mailing address:** PO BOX 279, ROSEVILLE, CA 95660-0279
- **Mailing address phone:** (916) 960-9176

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 09/16/2019