Provider Demographics
NPI:1518213602
Name:SHANE RETINA, P.A.
Entity Type:Organization
Organization Name:SHANE RETINA, P.A.
Other - Org Name:RETINA CARE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-351-1200
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2973
Mailing Address - Country:US
Mailing Address - Phone:941-351-1200
Mailing Address - Fax:941-351-1201
Practice Address - Street 1:2401 UNIVERSITY PKWY
Practice Address - Street 2:BUILDING 1, SUITE 205
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2893
Practice Address - Country:US
Practice Address - Phone:941-351-1200
Practice Address - Fax:941-351-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106610207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty