Organization
MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GRP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN MUSHOLT (BILLING MANAGER)
(916) 731-5955
Entity
Organization
Contact information
Practice address
635 ANDERSON RD, SUITE 1, DAVIS, CA 95616-3505
(530) 756-5040
(530) 756-9140
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
—
GR0042241
—
CA
Enumeration date
07/09/2006
Last updated
10/28/2016
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