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General NPI Number Information
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NPI Number | 1962955286
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Entity Type | Organization
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Legal Business Name | RETINA VITREOUS CONSULTANTS
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 8700 STONY POINT PKWY SUITE 230
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City | RICHMOND
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State | VA
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Zip | 23235-1962
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Country | US
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Telephone | 804-363-8948
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 FOUNDERS BRIDGE RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-6380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. ALI TABASSIAN
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Credential | MD
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Telephone | 804-363-8948
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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 | 0101054624
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License Number State | VA
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