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NPI Code Detail

MEDICARE: VITREO RETINAL ASSOCIATES PA

MEDICARE: VITREO RETINAL ASSOCIATES PA
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

General Provider Information

NPI Number : 1962626945
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITREO RETINAL ASSOCIATES PA
Provider Business Mailing Address
First Line : 4340 W NEWBERRY RD
Second Line : SUITE 202
City : GAINESVILLE
State : FL
Zip : 32607-2586
Country : US
Telephone Number : 352-371-2800
Fax Number : 352-378-7009
Provider Business Practice Location Address
First Line : 4340 W NEWBERRY RD STE 202
Second Line :
City : GAINESVILLE
State : FL
Zip : 32607-2557
Country : US
Telephone Number : 352-371-2800
Fax Number : 352-378-7009
Authorized Official
Title or Position : PHYSICIAN
Name : DR. KAUSHIK M HAZARIWALA
Credential : MD
Telephone Number : 352-371-2800
Provider Enumeration Date : 04/12/2007
Last Update Date : 06/19/2026

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Directions to “VITREO RETINAL ASSOCIATES PA ” Practice Location

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