NPIMap

Organization Active NPI

Vitreo Retinal Surgeons LLC

  • Ophthalmology Physician
  • Brooksville, FL
National Provider Identifier
1194714485
Registry record updated Sep 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
OS04712 Issued in FL
Legal business name
VITREO RETINAL SURGEONS LLC
Practice address
11373 Cortez Blvd
Ste 400
Brooksville, FL 34613-5414
Phone
(352) 597-2604
Fax
(352) 596-0520
NPI assigned
Oct 19, 2005
Last updated
Sep 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2008

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

Authorized official

Name
Thomas G Ward, DONPI 1609892595
Title
Physician Surgeon Owner
Phone
(352) 597-2604

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X OS04712 FL Primary

Addresses

Primary practice location

11373 Cortez Blvd
Ste 400
Brooksville, FL 34613-5414

Mailing address

11373 Cortez Blvd
Ste 400
Brooksville, FL 34613-5414
Phone (352) 597-2604

Other identifiers 1

IdentifierTypeStateIssuer
371161700MedicaidFL

National Provider Directory

National Provider Directory

Locations

11373 Cortez Blvd
Ste 400
Brooksville, FL 34613
Phone (352) 597-2604

Interoperability endpoints

  • Direct secure messaging: sbhullar@vrsllc.intellechartdirect.net
  • Direct secure messaging: tward@vrsllc.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221436800000",
    "number": "1194714485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11373 CORTEZ BLVD",
            "address_2": "STE 400",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135414",
            "telephone_number": "352-597-2604",
            "fax_number": "352-596-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11373 CORTEZ BLVD",
            "address_2": "STE 400",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135414",
            "telephone_number": "352-597-2604",
            "fax_number": "352-596-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITREO RETINAL SURGEONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-09-15",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN SURGEON OWNER",
        "authorized_official_telephone_number": "352-597-2604",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "OS04712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371161700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooksville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.