Organization
VITREO-RETINAL MEDICAL GROUP, INC.
Active
Other names
Retinal Consultants Medical Group, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS MENTINK (PRACTICE ADMINISTRATOR)
(916) 453-5450
Entity
Organization
Contact information
Practice address
3939 J ST STE 106, SACRAMENTO, CA 95819-3631
(916) 454-4861
(916) 454-3603
Mailing address
3939 J ST STE 104, SACRAMENTO, CA 95819-3631
(916) 454-6191
(916) 454-1036
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0199873
SAC. -DEPT. OF LABOR WA
WA
01
—
CP5300
SAC. OFFICE -RAILROAD MED
CA
05
—
GR0030320
—
CA
01
—
ZZZ82386Z
BLUE SHIELD CA
CA
Enumeration date
10/02/2006
Last updated
04/04/2008
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