NPIMap

Organization Active NPI

Retina Vitreous Center of Delaware P.a.

  • Ophthalmology Physician
  • Wilmington, DE
National Provider Identifier
1043230253
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
C10005728 Issued in DE
Legal business name
RETINA VITREOUS CENTER OF DELAWARE P.A.
Practice address
4514 Kirkwood Hwy
Wilmington, DE 19808-5118
Phone
(302) 993-0722
Fax
(302) 993-0754
NPI assigned
Jul 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Leo Santamarina, MDNPI 1659339646
Title
Owner
Phone
(410) 392-4976

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X C10005728 DE Primary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X D0062427 MD

Addresses

Primary practice location

4514 Kirkwood Hwy
Wilmington, DE 19808-5118

Mailing address

103 Chesapeake Blvd
Suite C
Elkton, MD 21921-6313
Phone (410) 392-4976

Other identifiers 1

IdentifierTypeStateIssuer
1000039342MedicaidDE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043230253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CHESAPEAKE BLVD",
            "address_2": "SUITE C",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219216313",
            "telephone_number": "410-392-4976",
            "fax_number": "410-392-4958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4514 KIRKWOOD HWY",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198085118",
            "telephone_number": "302-993-0722",
            "fax_number": "302-993-0754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA VITREOUS CENTER OF DELAWARE P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANTAMARINA",
        "authorized_official_first_name": "LEO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-392-4976",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "DE",
            "license": "C10005728",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D0062427",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000039342",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.