Organization
MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN MUSHOLT (BILLING MGR)
(916) 731-5955
Entity
Organization
Contact information
Practice address
1561 CREEKSIDE DR, SUITE 160, FOLSOM, CA 95630-3492
(916) 983-4550
(916) 983-8569
Mailing address
1700 ALHAMBRA BLVD, SUITE 202, SACRAMENTO, CA 95816-7050
(916) 731-8040
(916) 454-4152
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0042245
—
CA
Enumeration date
07/08/2006
Last updated
10/02/2007
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