Provider Demographics
NPI:1710913926
Name:VITREO-RETINAL ASSOCIATES P.C.
Entity Type:Organization
Organization Name:VITREO-RETINAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-285-1200
Mailing Address - Street 1:2505 EAST PARIS AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2459
Mailing Address - Country:US
Mailing Address - Phone:616-285-1200
Mailing Address - Fax:616-940-0864
Practice Address - Street 1:2505 EAST PARIS AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2459
Practice Address - Country:US
Practice Address - Phone:616-285-1200
Practice Address - Fax:616-940-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32900Medicare PIN