# VITREO RETINAL SURGEONS LLC

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

## Provider details

- **NPI number:** 1194714485
- **Authorized official:** THOMAS G WARD DO (PHYSICIAN SURGEON OWNER)
- **Authorized official phone:** (352) 597-2604

## Contact information

- **Practice address:** 11373 CORTEZ BLVD, STE 400, BROOKSVILLE, FL 34613-5414
- **Practice address phone:** (352) 597-2604
- **Practice address fax:** (352) 596-0520
- **Mailing address:** 11373 CORTEZ BLVD, STE 400, BROOKSVILLE, FL 34613-5414
- **Mailing address phone:** (352) 597-2604
- **Mailing address fax:** (352) 596-0520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | OS04712 | FL | Yes |

## Other

- **Enumeration date:** 10/19/2005
- **Last updated:** 09/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 371161700 | — | FL |