Provider Demographics
NPI:1770144727
Name:VENICE RETINA, P.A.
Entity type:Organization
Organization Name:VENICE RETINA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-202-1900
Mailing Address - Street 1:871 VENETIA BAY BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8049
Mailing Address - Country:US
Mailing Address - Phone:941-202-1900
Mailing Address - Fax:941-786-3358
Practice Address - Street 1:871 VENETIA BAY BLVD STE 115
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8047
Practice Address - Country:US
Practice Address - Phone:941-202-1900
Practice Address - Fax:941-786-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty