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General NPI Number Information
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NPI Number | 1477603074
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Entity Type | Organization
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Legal Business Name | VITREORETINAL EYE CENTER, PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 962 TOMMY MUNRO DR STE E
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City | BILOXI
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State | MS
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Zip | 39532-2139
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Country | US
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Telephone | 228-388-7000
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Fax | 833-849-9899
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Provider Business Mailing Address
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Address Line | 962 TOMMY MUNRO DR STE E
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City | BILOXI
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State | MS
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Zip | 39532-2139
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Country | US
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Telephone | 228-388-7000
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Fax | 833-849-9899
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. AVIT J GREMILLION
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Credential | MD
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Telephone | 228-388-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 023984
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 17239
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License Number State | MS
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