Provider Demographics
NPI:1902001464
Name:RETINA VITREOUS SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:RETINA VITREOUS SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FURMANSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-463-4313
Mailing Address - Street 1:23 HACKETT BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3436
Mailing Address - Country:US
Mailing Address - Phone:518-463-4313
Mailing Address - Fax:518-463-3436
Practice Address - Street 1:23 HACKETT BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3436
Practice Address - Country:US
Practice Address - Phone:518-463-4313
Practice Address - Fax:518-463-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55453AMedicare ID - Type Unspecified