Healthcare Provider Details

I. General information

NPI: 1699773796
Provider Name (Legal Business Name): RETINA VITREOUS CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 N FEDERAL HWY SUITE 300
FT LAUDERDALE FL
33308-1907
US

IV. Provider business mailing address

6333 N FEDERAL HWY STE 300
FT LAUDERDALE FL
33308-1909
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-6880
  • Fax: 954-229-3100
Mailing address:
  • Phone: 954-776-6880
  • Fax: 954-229-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT ARTHUR LALANE III
Title or Position: MD
Credential:
Phone: 919-801-1103