Organization
VITREO-RETINAL CONSULTANTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A. GERSMAN M.D. (VICE PRESIDENT)
(330) 494-1116
Entity
Organization
Contact information
Practice address
4676 DOUGLAS CIR NW, CANTON, OH 44718-3619
(330) 494-1116
(330) 494-0276
Mailing address
4676 DOUGLAS CIR NW, CANTON, OH 44718-3619
(330) 494-1116
(330) 494-0276
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015118480004
—
PA
05
—
0693576
—
OH
05
—
6300115000
—
WV
Enumeration date
04/21/2006
Last updated
10/06/2021
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