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NPI Code Detail

MEDICARE: VITREO-RETINAL CONSULTANTS, INC.

MEDICARE: VITREO-RETINAL CONSULTANTS, INC.
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
1207W00000XOphthalmology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750347662
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITREO-RETINAL CONSULTANTS, INC.
Provider Business Mailing Address
First Line : 4676 DOUGLAS CIR NW
Second Line :
City : CANTON
State : OH
Zip : 44718-3619
Country : US
Telephone Number : 330-494-1116
Fax Number : 330-494-0276
Provider Business Practice Location Address
First Line : 4676 DOUGLAS CIR NW
Second Line :
City : CANTON
State : OH
Zip : 44718-3619
Country : US
Telephone Number : 330-494-1116
Fax Number : 330-494-0276
Authorized Official
Title or Position : VICE PRESIDENT
Name : MARK A. GERSMAN
Credential : M.D.
Telephone Number : 330-494-1116
Provider Enumeration Date : 04/21/2006
Last Update Date : 10/06/2021

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1205839552 — DR. MARK ANDREW GERSMAN M.D.
Practice Location Address:
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CANTON, OH
44718-3619
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Practice Fax: 330-494-0276
1639172984 — DR. ROBERT EDWARD WENZ M.D.
Practice Location Address:
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44718-3619
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1568464832 — DR. STEPHEN RICHARD KAUFMAN M.D.
Practice Location Address:
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44718-3619
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1134121577 — DR. RICHARD E WYSZYNSKI M.D.
Practice Location Address:
4676 DOUGLAS CIR NW
CANTON, OH
44718-3619
Practice Phone: 330-494-1116
Practice Fax: 330-494-0276

Directions to “VITREO-RETINAL CONSULTANTS, INC. ” Practice Location

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