Organization
RETINA GROUP OF TIDEWATER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENKAT MANORANJAN REDDY MD (PHYSICIAN/OWNER)
(757) 622-7000
Entity
Organization
Contact information
Practice address
400 GRESHAM DR STE 308, NORFOLK, VA 23507-1901
(757) 622-7000
(757) 623-6708
Mailing address
400 GRESHAM DR STE 308, NORFOLK, VA 23507-1901
(757) 622-7000
(757) 623-6708
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101051339
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6303251
—
VA
Enumeration date
02/04/2008
Last updated
12/08/2011
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