MEDICARE: RETINA VITROUS CONSULTANTS OF WEST FLORIDA PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1144321571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA VITROUS CONSULTANTS OF WEST FLORIDA PL

Provider Business Mailing Address
First Line	:	5347 MAIN ST
Second Line	:	SUITE 102
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2506
Country	:	US
Telephone Number	:	727-845-1343
Fax Number	:	727-842-9523

Provider Business Practice Location Address
First Line	:	5347 MAIN ST
Second Line	:	SUITE 102
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2506
Country	:	US
Telephone Number	:	727-845-1343
Fax Number	:	727-842-9523

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DEBORA A KAPLAN
Credential	:
Telephone Number	:	727-868-9442

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/14/2007

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