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Organization

VITREO-RETINAL MEDICAL GROUP, INC.

Active
Other names
Modesto Retina Center, Inc.
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOEL PEARLMAN MD (PRESIDENT)
(916) 596-2027
Entity
Organization

Contact information

Practice address
4712 STODDARD RD, MODESTO, CA 95356-9404
(209) 549-8444
(209) 549-8443
Mailing address
3 PARK CENTER DR STE 210, SACRAMENTO, CA 95825-8341
(916) 596-2027
(866) 913-6557

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0199873
DEPT. OF LABOR WA
WA
01
CP5300
RAILROAD MEDICARE
CA
05
GR0030323
CA
01
ZZZ29020Z
BLUE SHIELD CA
CA
01
ZZZ32011Z
WORKERS COMP
CA
Enumeration date
10/02/2006
Last updated
10/06/2023
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