1699773796 NPI number — RETINA VITREOUS CONSULTANTS LLP

Table of content: (NPI 1699773796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699773796 NPI number — RETINA VITREOUS CONSULTANTS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA VITREOUS CONSULTANTS LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699773796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6333 N FEDERAL HWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-1907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-776-6880
Provider Business Mailing Address Fax Number:
954-229-3100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6333 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-776-6880
Provider Business Practice Location Address Fax Number:
954-229-3100
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TANEY
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
954-776-6880

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0107X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0108X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114738410 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738416 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738417 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116137108 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116137119 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738415 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738419 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116137111 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738401 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738402 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738403 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738409 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116137101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738404 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738408 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738411 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738413 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116137105 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114738406 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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