Medical Vision Technology Ophthalmology Medical GRP, Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GRP, INC.

Practice address

635 Anderson Rd
Suite 1
Davis, CA 95616-3505

Phone

(530) 756-5040

Fax

(530) 756-9140

NPI assigned

Jul 9, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joann Musholt

Title

Billing Manager

Phone

(916) 731-5955

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Medical Vision Technology Ophthalmology Medical Group Inc.

  • Ophthalmology Physician
  • Sacramento, CA
  • NPI 1013940519

  O20040608001193

  Same enrollment
• Medical Vision Technology Ophthalmology Medical Group Inc.

  • Ophthalmology Physician
  • Roseville, CA
  • NPI 1609809144

  O20040608001193

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexander Grand, MD

  • Ophthalmology Physician
  • Sacramento, CA
  • NPI 1861694077
  NPD
• Robert Ross Peabody Jr., MD

  • Ophthalmology Physician
  • Sacramento, CA
  • NPI 1801802095
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477612800000",
    "number": "1396778718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 ALHAMBRA BLVD",
            "address_2": "SUITE 202",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167050",
            "telephone_number": "916-731-8040",
            "fax_number": "916-454-4152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 ANDERSON RD",
            "address_2": "SUITE 1",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163505",
            "telephone_number": "530-756-5040",
            "fax_number": "530-756-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GRP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "MUSHOLT",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "916-731-5955"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0042241",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles J McNeil, LCSW
• Kenneth Blair McNeill, LPCC
• Heidi McNulty, DO
• Jean Marion McSorley, LCSW
• Medcore Inc
• Isabel Medina
• Nader Mehra
• James Daniel Meinert, DDS
• Mariah Melder, PTA
• Kathryn Anne Meldrum

• Ophthalmology Physician in Davis, CA
• Providers in Davis, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.