Retina Vitreous Center, PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301039556 Issued in MI

Legal business name

RETINA VITREOUS CENTER, PC

Practice address

3181 E Grand Blanc Rd
Grand Blanc, MI 48439-8117

Phone

(810) 694-6933

Fax

(810) 694-5295

NPI assigned

Jun 21, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Cathy McLeod

Title

Office Manager

Phone

(810) 694-6933

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255651200000",
    "number": "1811192537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 E GRAND BLANC RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398117",
            "telephone_number": "810-694-6933",
            "fax_number": "810-694-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 E GRAND BLANC RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398117",
            "telephone_number": "810-694-6933",
            "fax_number": "810-694-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA VITREOUS CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2009-10-16",
        "status": "A",
        "authorized_official_last_name": "MCLEOD",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "810-694-6933",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301039556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104101440",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102706763",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; 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.