VITREO-RETINAL MEDICAL GROUP, INC. (NPI# 1083707822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083707822 |
| Entity Type | Organization |
| Organization Name | VITREO-RETINAL MEDICAL GROUP, INC. |
| Other Organization Name | RETINA CENTER OF STOCKTON, INC. |
| Practice Address |
3555 Deer Park Dr Suite 180 Stockton CA 95219-2377 |
| Mailing Address |
3939 J St Suite 104 Sacramento CA 95819-3631 |
| Practice Telephone | 2094615291 |
| Practice Fax Number | 2094629246 |
| Mailing Telephone | 9164535450 |
| Mailing Fax Number | 9164541036 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-08-15 |
| Authorized Official Name | DR. ROBERT WENDEL (PRESIDENT) |
| Authorized Official Telephone | 9164535450 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | DEPT OF LABOR WA | 0199873 | 01 |
| CA | BLUE SHIELD CA | ZZZ14095Z | 01 |
| CA | RAILROAD MEDI-CARE | CP5300 | 01 |
| CA | GR0030322 | 05 | |
| CA | WORKERS COMP. | ZZZ14095Z | 01 |
| Other Name | Type Code |
|---|---|
| Retina Center of Stockton, Inc. | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710212782 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 1548 N Tracy Blvd, Tracy, CA 95376-2903 | 2009-10-08 |
| 1497897532 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 2470 Hilborn Rd, Suite 150, Fairfield, CA 94534-1100 | 2007-02-13 |
| 1770646119 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 3939 J St Ste 104, Sacramento, CA 95819-3631 | 2006-12-18 |
| 1184717167 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 19 Ilahee Ln, Chico, CA 95973-7205 | 2006-10-02 |
| 1841383882 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 5775 Greenback Ln, Sacramento, CA 95841-2013 | 2006-10-02 |
| 1942842984 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 3 Parkcenter Dr, Ste 100, Sacramento, CA 95825-8340 | 2019-10-10 |
| 1215189360 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 300 Sierra College Dr, Suite 265, Grass Valley, CA 95945-5082 | 2008-10-21 |
| 1821181850 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 3939 J St Ste 106, Sacramento, CA 95819-3631 | 2006-10-02 |
| 1114010949 | Vitreo-retinal Medical Group, Inc. | Ophthalmology | 1401 Spanos Ct, Suite 223, Modesto, CA 95355-2810 | 2006-10-02 |
| Street Address |
3555 DEER PARK DR SUITE 180 |
| City | STOCKTON |
| State | CA |
| Zip Code | 95219-2377 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144260811 | Wellbound of Stockton LLC | Clinic/Center | 3555 Deer Park Dr, Suite 140, Stockton, CA 95219-2306 | 2006-06-08 |
| 1407267446 | Ivan Chicchon | Dentist | 3555 Deer Park Dr, Stockton, CA 95219-2377 | 2014-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821568494 | Vanessa Paola Uribe Morales | Behavior Technician | 3620 Hammer Lane, Stockton, CA 95219 | 2018-11-27 |
| 1306316930 | Zulema Cecilia Santana | Behavior Technician | 3620 W. Hammer Ln, Stockton, CA 95219 | 2018-11-27 |
| 1699245241 | Tiana Gonzalez | Behavior Technician | 3620 W. Hammer Ln., Stockton, CA 95219 | 2018-11-27 |
| 1609346220 | Kelly Morales | Behavior Technician | 3620 W Hammer Lane, Stockton, CA 95219 | 2018-11-26 |
| 1336619956 | Mouagoleah Her | Behavior Technician | 3620 W. Hammer Lane, Stockton, CA 95219 | 2018-11-26 |
| 1750837985 | Alexsandra Trejo | Marriage & Family Therapist | 6707 Embarcadero Drive, Stockton, CA 95219 | 2016-08-28 |
| 1659764397 | Integrated Pain Treatment Center | Pain Medicine | 4312 Feather River Drive, Suite C, Stockton, CA 95219 | 2015-03-05 |
| 1790180859 | Mary Karen Papagolos | Marriage & Family Therapist | 2800 W March Ln Ste 473, Stockton, CA 95219 | 2014-10-30 |
| 1932535648 | Morton Rothbard | Urology | 4673 Pine Valley Cir., Stockton, CA 95219 | 2013-09-26 |
| 1033482591 | Michelle M Rutherford | Physical Therapist | 10200 Trinity Pkwy Ste 205, Stockton, CA 95219 | 2012-02-14 |
| Find all providers in zip 95219 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437258183 | Stevens Young-jun Kim | Ophthalmology | 36 West Yokuts Ave, Suite 1, Stockton, CA 95207-5713 | 2006-09-21 |
| 1871600114 | Jeffrey John Ing | Ophthalmology | 1617 Saint Marks Plz, Suite D, Stockton, CA 95207-6423 | 2006-08-24 |
| 1891703229 | Harold E Hand | Ophthalmology | 1801 E March Ln C350, Stockton, CA 95210-6674 | 2006-08-03 |
| 1740214634 | Zeiter Eye Medical Group, Inc. | Ophthalmology | 255 E Weber Ave, Stockton, CA 95202-2706 | 2006-07-10 |
| 1366493629 | Kimberly P. Cockerham | Ophthalmology | 36 W Yokuts Ave, Stockton, CA 95207-5713 | 2006-05-12 |
| 1215928775 | California's Advanced Institute of Vision Medical Group, Inc | Ophthalmology | 1801 E March Lane C350, Stockton, CA 95210-6674 | 2005-11-03 |
| 1639550130 | Majid Roubach | Ophthalmology | 1899 W March Ln, Stockton, CA 95207 | 2015-06-11 |
| 1104242924 | Charles Kim | Ophthalmology | 1899 W March Ln, Stockton, CA 95207-6402 | 2014-03-18 |
| 1821331034 | Sarah Lauren Dehaybi | Ophthalmology | 1899 W March Ln, Stockton, CA 95207-6402 | 2013-04-05 |
| 1447510953 | Usiwoma Esenighe Ene Abugo | Ophthalmology | 36 W Yokuts Ave, Suite 1, Stockton, CA 95207-5713 | 2012-05-18 |
| Find all providers in STOCKTON | ||||
Please comment or provide details below to improve the information on VITREO-RETINAL MEDICAL GROUP, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.