MEDICARE: FLORIDA RETINA AND VITREOUS 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	174400000X	Specialist	ME76040	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB6442	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	7746537	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1477659282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA RETINA AND VITREOUS CENTER

Provider Business Mailing Address
First Line	:	4624 HALDER LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6435
Country	:	US
Telephone Number	:	407-897-7470
Fax Number	:	407-897-7473

Provider Business Practice Location Address
First Line	:	4624 HALDER LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6435
Country	:	US
Telephone Number	:	407-897-7470
Fax Number	:	407-897-7473

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT J KRAUT
Credential	:	M.D.
Telephone Number	:	407-897-7470

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/29/2010

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Directions to “FLORIDA RETINA AND VITREOUS CENTER ” Practice Location

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