Provider Demographics
NPI:1083784086
Name:RETINA ASSOCIATES OF SPOKANE PS
Entity Type:Organization
Organization Name:RETINA ASSOCIATES OF SPOKANE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MILSOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-232-8731
Mailing Address - Street 1:520 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1315
Mailing Address - Country:US
Mailing Address - Phone:509-232-8731
Mailing Address - Fax:509-747-0806
Practice Address - Street 1:520 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1315
Practice Address - Country:US
Practice Address - Phone:509-232-8731
Practice Address - Fax:509-747-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty