MEDICARE: SOUTH FLORIDA RETINA CORP

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	152WC0802X	Corneal and Contact Management Optometrist

General Provider Information

NPI Number	:	1447707773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA RETINA CORP

Provider Business Mailing Address
First Line	:	6280 W SAMPLE RD
Second Line	:	SUITE 202
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3173
Country	:	US
Telephone Number	:	502-552-8581
Fax Number	:

Provider Business Practice Location Address
First Line	:	8292 EMERALD AVE
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33076-4430
Country	:	US
Telephone Number	:	502-552-8581
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN KRITCHMAN
Credential	:	M.D.
Telephone Number	:	502-552-8581

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	09/02/2016

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Directions to “SOUTH FLORIDA RETINA CORP ” Practice Location

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