# TOTAL RETINA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063526713
- **Authorized official:** RANDALL V WONG MD (PRESIDENT)
- **Authorized official phone:** (410) 377-9004

## Contact information

- **Practice address:** 6115 FALLS RD, SUITE 300, BALTIMORE, MD 21209-2219
- **Practice address phone:** (410) 377-9004
- **Practice address fax:** (410) 377-8221
- **Mailing address:** 6115 FALLS RD, SUITE 300, BALTIMORE, MD 21209-2219
- **Mailing address phone:** (410) 377-9004
- **Mailing address fax:** (410) 377-8221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | D0041207 | MD | Yes |

## Other

- **Enumeration date:** 08/19/2006
- **Last updated:** 06/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 497691600 | — | MD |