Organization
VITREO-RETINAL ASSOCIATES MEDICAL GROUP
Active
Organization
VITREO-RETINAL ASSOCIATES MEDICAL GROUP
Active
Parent organization
VITREO-RETINAL ASSOCIATES MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
VITREO-RETINAL ASSOCIATES MEDICAL GROUP
Authorized official
LAWRENCE JOSEPH KONDRA MD (PARTNERSHIP)
(626) 440-9920
Entity
Organization
Contact information
Practice address
160 E ARTESIA BLVD, SUITE 345, POMONA, CA 91767-2922
(909) 865-7990
(909) 865-0931
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
—
GR0046201
—
CA
01
—
W11190A
MEDICARE
—
Enumeration date
08/13/2006
Last updated
01/02/2018
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