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General NPI Number Information
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NPI Number | 1316000102
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Entity Type | Organization
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Legal Business Name | RETINAL & MACULAR CONSULTANTS, P.A,
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD SUITE 403
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City | AVENTURA
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State | FL
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Zip | 33180-1227
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Country | US
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Telephone | 305-933-9445
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Fax | 305-933-9446
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Provider Business Mailing Address
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Address Line | 21110 BISCAYNE BLVD SUITE 403
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City | AVENTURA
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State | FL
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Zip | 33180-1227
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Country | US
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Telephone | 305-933-9445
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Fax | 305-933-9446
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE T REESE
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Credential | M.D.
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Telephone | 305-933-9445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME 29298
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License Number State | FL
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