MEDICARE: RETINA VITREAUS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1326087156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA VITREAUS CENTER

Provider Business Mailing Address
First Line	:	1700 GALLOPING HILL RD
Second Line	:
City	:	KENILWORTH
State	:	NJ
Zip	:	07033-1303
Country	:	US
Telephone Number	:	908-488-8333
Fax Number	:	908-458-8339

Provider Business Practice Location Address
First Line	:	1700 GALLOPING HILL RD
Second Line	:
City	:	KENILWORTH
State	:	NJ
Zip	:	07033-1303
Country	:	US
Telephone Number	:	908-488-8333
Fax Number	:	908-458-8339

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MR. EDWARD J LUDWIG III
Credential	:	FACMPE
Telephone Number	:	732-568-1246

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/05/2008

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Directions to “RETINA VITREAUS CENTER ” Practice Location

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