| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Ophthalmology |
| DEFINITION | An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| AREA OF SPECIALIZATION | Retina Specialist |
| STATUS | Active |
| VA CODE | V113003 |
| X12 CODE | 207WX0107X |
| SPECIALTY CODE | 18 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251790 |
| EFFECTIVE DATE/TIME |
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