Provider Demographics
NPI:1982946612
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:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-655-0411
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:305-653-6300
Practice Address - Street 1:184 NE 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3412
Practice Address - Country:US
Practice Address - Phone:305-655-0411
Practice Address - Fax:305-653-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269577400Medicaid
FL063692402Medicaid
FL262475300Medicaid
FL269577400Medicaid
FL262475300Medicaid
FL063692402Medicaid