Total Retina LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

D0041207 Issued in MD

Legal business name

TOTAL RETINA LLC

Practice address

6115 Falls Rd
Suite 300
Baltimore, MD 21209-2219

Phone

(410) 377-9004

Fax

(410) 377-8221

NPI assigned

Aug 19, 2006

Last updated

Jun 27, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randall V Wong, MD

Title

President

Phone

(410) 377-9004

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1063526713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6115 FALLS RD",
            "address_2": "SUITE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092219",
            "telephone_number": "410-377-9004",
            "fax_number": "410-377-8221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6115 FALLS RD",
            "address_2": "SUITE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092219",
            "telephone_number": "410-377-9004",
            "fax_number": "410-377-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RETINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-377-9004",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D0041207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497691600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Ophthalmology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.