Provider Demographics
NPI:1124042601
Name:RETINA ASSOCIATES OF ALABAMA, INC
Entity Type:Organization
Organization Name:RETINA ASSOCIATES OF ALABAMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-712-1700
Mailing Address - Street 1:PO BOX 8008
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36304-0008
Mailing Address - Country:US
Mailing Address - Phone:334-712-1700
Mailing Address - Fax:334-699-1715
Practice Address - Street 1:160 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1996
Practice Address - Country:US
Practice Address - Phone:334-712-1700
Practice Address - Fax:334-699-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025149207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty