Provider Demographics
NPI:1144806787
Name:OPHTHALMOLOGY AND RETINA ASSOCIATES
Entity Type:Organization
Organization Name:OPHTHALMOLOGY AND RETINA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-655-4362
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0315
Mailing Address - Country:US
Mailing Address - Phone:409-750-2576
Mailing Address - Fax:
Practice Address - Street 1:1500 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2345
Practice Address - Country:US
Practice Address - Phone:304-845-0908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV25265OtherSTATE LICENSE