Organization
VITREO-RETINAL ASSOCIATES MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE JOSEPH KONDRA MD (PARTNERSHIP)
(626) 440-9920
Entity
Organization
Contact information
Practice address
800 FAIRMOUNT AVE STE 120, PASADENA, CA 91105-3151
(626) 440-9920
(626) 440-0351
Mailing address
800 FAIRMOUNT AVE STE 120, PASADENA, CA 91105-3151
(626) 440-9920
(626) 440-0351
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180003746
MEDICARE RAILROAD
CA
01
—
CS9651
MEDICARE RAILROAD
CA
05
—
GR0046200
—
CA
01
—
W11190
MEDICARE
CA
Enumeration date
07/01/2006
Last updated
01/02/2018
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