Provider Demographics
NPI:1184717167
Name:VITREO-RETINAL MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:VITREO-RETINAL MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-596-2027
Mailing Address - Street 1:3 PARK CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8341
Mailing Address - Country:US
Mailing Address - Phone:916-596-2027
Mailing Address - Fax:916-454-1036
Practice Address - Street 1:2460 BEACON ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9224
Practice Address - Country:US
Practice Address - Phone:530-899-2251
Practice Address - Fax:530-894-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0199873OtherDEPT OF LABOR WA - CHICO
CAZZZ31103ZOtherCHICO-WORKERS COMP
CACP5300OtherRAILROAD MEDICARE
CAGR0030324Medicaid
CAZZZ41244ZOtherBLUE SHIELD CA GROUP #
CAZZZ31103ZOtherCHICO-WORKERS COMP