Provider Demographics
NPI:1699773796
Name:RETINA VITREOUS CONSULTANTS
Entity type:Organization
Organization Name:RETINA VITREOUS CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-776-6880
Mailing Address - Street 1:6333 N FEDERAL HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1907
Mailing Address - Country:US
Mailing Address - Phone:954-776-6880
Mailing Address - Fax:954-229-3100
Practice Address - Street 1:6333 N FEDERAL HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1907
Practice Address - Country:US
Practice Address - Phone:954-776-6880
Practice Address - Fax:954-229-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
207WX0107X, 207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114738400Medicaid
FL114738416Medicaid
FL116137110Medicaid
FL114738406Medicaid
FL114738414Medicaid
FL114738401Medicaid
FL114738402Medicaid
FL114738409Medicaid
FL114738413Medicaid
FL114738417Medicaid
FL114738418Medicaid
FL116137105Medicaid
FL116137108Medicaid
FL114738403Medicaid
FL114738404Medicaid
FL114738411Medicaid
FL114738412Medicaid
FL116137111Medicaid
FL116137119Medicaid
FL114738419Medicaid
FL114738408Medicaid
FL114738407Medicaid
FL114738410Medicaid
FL114738415Medicaid
FL116137101Medicaid