Provider Demographics
NPI:1790964179
Name:VITREOUS AND RETINA CONSULTANTS PA
Entity Type:Organization
Organization Name:VITREOUS AND RETINA CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-297-5400
Mailing Address - Street 1:4180 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5515
Mailing Address - Country:US
Mailing Address - Phone:863-297-5400
Mailing Address - Fax:863-293-8230
Practice Address - Street 1:4180 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5515
Practice Address - Country:US
Practice Address - Phone:863-297-5400
Practice Address - Fax:863-293-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372196500Medicaid
FL39178AMedicare PIN