Provider Demographics
NPI:1912930330
Name:VITREO-RETINAL ASSOCIATES OF WORCESTER PC
Entity Type:Organization
Organization Name:VITREO-RETINAL ASSOCIATES OF WORCESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RHEAUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-752-1155
Mailing Address - Street 1:67 BELMONT ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2657
Mailing Address - Country:US
Mailing Address - Phone:508-752-1155
Mailing Address - Fax:508-752-4862
Practice Address - Street 1:67 BELMONT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2657
Practice Address - Country:US
Practice Address - Phone:508-752-1155
Practice Address - Fax:508-752-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9723838Medicaid
MA9723838Medicaid