Organization
CAPITAL EYE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITRA AYAZIFAR MD (OWNER)
(916) 960-9176
Entity
Organization
Contact information
Practice address
817 COURT ST STE 10, JACKSON, CA 95642-2156
(209) 223-2020
(209) 223-2046
Mailing address
PO BOX 279, ROSEVILLE, CA 95660-0279
(916) 960-9176
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
11/27/2013
Last updated
09/16/2019
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