Organization
EYE SITE SACRAMENTO MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M VAN DUYN (PRACTICE MANAGER)
(916) 452-8105
Entity
Organization
Contact information
Practice address
4925 J ST, SACRAMENTO, CA 95819-3828
(916) 452-8105
(916) 452-4659
Mailing address
4925 J ST, SACRAMENTO, CA 95819-3828
(916) 452-8105
(916) 452-4659
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0095580
—
CA
Enumeration date
07/22/2006
Last updated
03/04/2008
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