Provider Demographics
NPI:1982021523
Name:RETINA MACULA SPECIALISTS OF MIAMI LLC
Entity Type:Organization
Organization Name:RETINA MACULA SPECIALISTS OF MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-653-6500
Mailing Address - Street 1:184 NE 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3412
Mailing Address - Country:US
Mailing Address - Phone:305-655-0411
Mailing Address - Fax:305-655-0499
Practice Address - Street 1:6705 S RED RD STE 514
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3644
Practice Address - Country:US
Practice Address - Phone:305-655-0411
Practice Address - Fax:305-655-0499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RETINA MACULA SPECIALISTS OF MIAMI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-20
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86697207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269577402Medicaid
FL37551UMedicare PIN
FLI09777Medicare UPIN