Provider Demographics
NPI:1306808167
Name:RETINA INSTITUTE OF VIRGINIA PLLC
Entity type:Organization
Organization Name:RETINA INSTITUTE OF VIRGINIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:VEDITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-644-7478
Mailing Address - Street 1:8720 STONY POINT PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1989
Mailing Address - Country:US
Mailing Address - Phone:804-644-7478
Mailing Address - Fax:804-644-8224
Practice Address - Street 1:8720 STONY POINT PKWY STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1989
Practice Address - Country:US
Practice Address - Phone:804-644-7478
Practice Address - Fax:804-644-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06643OtherPTAN