Organization
RETINA VITREOUS CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHY MCLEOD (OFFICE MANAGER)
(810) 694-6933
Entity
Organization
Contact information
Practice address
3181 E GRAND BLANC RD, GRAND BLANC, MI 48439-8117
(810) 694-6933
(810) 694-5295
Mailing address
3181 E GRAND BLANC RD, GRAND BLANC, MI 48439-8117
(810) 694-6933
(810) 694-5295
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301039556
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102706763
—
MI
05
—
104101440
—
MI
Enumeration date
06/21/2007
Last updated
10/16/2009
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