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General NPI Number Information
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NPI Number | 1861525305
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Entity Type | Organization
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Legal Business Name | MANDELL RETINA CENTER PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 397 LITTLE NECK RD 3300 SOUTH BUILDING SUITE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5765
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Country | US
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Telephone | 757-227-4300
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Fax | 757-486-3125
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Provider Business Mailing Address
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Address Line | 397 LITTLE NECK RD 3300 SOUTH BUILDING SUITE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5765
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Country | US
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Telephone | 757-227-4300
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Fax | 757-486-3125
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Authorized Official
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Title or Position | ADMIN
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Name | JEANETTE M BASL
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Credential |
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Telephone | 757-227-4300
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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 |
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License Number State |
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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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