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General NPI Number Information
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NPI Number | 1922295641
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Entity Type | Organization
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Legal Business Name | RETINA AND MACULA CONSULTANTS PA
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 2400 S MCCALL RD SUITE A
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City | ENGLEWOOD
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State | FL
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Zip | 34224-5137
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Country | US
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Telephone | 941-460-9159
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Fax | 941-460-9419
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Provider Business Mailing Address
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Address Line | 2400 S MCCALL RD SUITE A
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City | ENGLEWOOD
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State | FL
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Zip | 34224-5137
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Country | US
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Telephone | 941-460-9159
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Fax | 941-460-9419
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHARLES M GREMILLION JR.
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Credential | M.D.
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Telephone | 941-460-9159
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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 | 57634
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License Number State | FL
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