VITREO-RETINAL MEDICAL GROUP INC. NPI 1114010949

NPI Information

NPI: 1114010949
Provider Name: VITREO-RETINAL MEDICAL GROUP, INC.
Classification: Ophthalmology - 207WX0107X
Specialization: Retina Specialist
Entity Type: Organization
Doing Business As: MODESTO RETINA CENTER, INC.
Address: 4712 STODDARD RD
MODESTO, CA
ZIP 95356
Phone: (209) 549-8444

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NPI Details

VITREO-RETINAL MEDICAL GROUP, INC. is a retina specialist ophthalmology in Modesto, CA. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. VITREO-RETINAL MEDICAL GROUP, INC. NPI is 1114010949. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Modesto Retina Center, Inc..

The provider's business location address is:

4712 STODDARD RD
MODESTO, CA
ZIP 95356-404
Phone: (209) 549-8444
Fax: (209) 549-8443

The provider's authorized official is Joel Pearlman .
The authorized official title is President and has the following contact phone number (916) 596-2027.

The enumeration date for this NPI number is 10/2/2006 and was last updated on 10/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207W00000X	Ophthalmology				No
2	207WX0107X	Ophthalmology	Retina Specialist			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CP5300	OTHER	CALIFORNIA	RAILROAD MEDICARE
2	ZZZ32011Z	OTHER	CALIFORNIA	WORKERS COMP
3	0199873	OTHER	WASHINGTON	DEPT. OF LABOR WA
4	GR0030323	MEDICAID	CALIFORNIA
5	ZZZ29020Z	OTHER	CALIFORNIA	BLUE SHIELD CA

What is NPI?

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This page was last updated on: 3/30/2025

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