Provider Demographics
NPI:1326814963
Name:RETINA MACULA INSTITUTE OF ARIZONA
Entity Type:Organization
Organization Name:RETINA MACULA INSTITUTE OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAMI
Authorized Official - Last Name:BARAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-613-5472
Mailing Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4135
Mailing Address - Country:US
Mailing Address - Phone:602-613-5473
Mailing Address - Fax:602-613-5474
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4135
Practice Address - Country:US
Practice Address - Phone:602-613-5473
Practice Address - Fax:602-613-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty