Healthcare Provider Details

I. General information

NPI: 1588892244
Provider Name (Legal Business Name): VITREO-RETINAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BELMONT ST STE 302
WORCESTER MA
01605-2608
US

IV. Provider business mailing address

67 BELMONT ST STE 302
WORCESTER MA
01605-2608
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-1155
  • Fax: 508-752-4862
Mailing address:
  • Phone: 508-752-1155
  • Fax: 508-752-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0013345
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMEDICARE PTAN
# 2
IdentifierM19742
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBC/BS GROUP NUMBER
# 3
Identifier110068662A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: AUNDREA BORELLI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-752-1155