Provider Demographics
NPI:1356076442
Name:TEXAS RETINA CONSULTANTS
Entity Type:Organization
Organization Name:TEXAS RETINA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-422-7300
Mailing Address - Street 1:7323 N LOOP 1604 E BLDG 4
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5603
Mailing Address - Country:US
Mailing Address - Phone:352-422-7300
Mailing Address - Fax:
Practice Address - Street 1:7323 N LOOP 1604 E BLDG 4
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-5603
Practice Address - Country:US
Practice Address - Phone:352-422-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty