Retina Group of Tidewater PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

0101051339 Issued in VA

Legal business name

RETINA GROUP OF TIDEWATER PC

Practice address

400 Gresham Dr Ste 308
Norfolk, VA 23507-1901

Phone

(757) 622-7000

Fax

(757) 623-6708

NPI assigned

Feb 4, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Venkat Manoranjan Reddy, MDNPI 1437169042

Title

Physician/Owner

Phone

(757) 622-7000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

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

• Venkat Manoranjan Reddy, M.D.

  • Surgery Physician
  • Virginia Beach, VA
  • NPI 1437169042
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1629256441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GRESHAM DR STE 308",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071901",
            "telephone_number": "757-622-7000",
            "fax_number": "757-623-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GRESHAM DR STE 308",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071901",
            "telephone_number": "757-622-7000",
            "fax_number": "757-623-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA GROUP OF TIDEWATER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "VENKAT",
        "authorized_official_middle_name": "MANORANJAN",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "757-622-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101051339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6303251",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rest Haven LLC
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• Retinal Consultants Inc (mark j mccarthy md)
• Christopher Raphael Rettenmaier, MD
• Nicholas Battista Rettenmaier, MD
• Bonnie Caukins Revelle, MD
• Revitalize Behavioral Services, LLC

• Ophthalmology Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Ophthalmology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.