Provider Demographics
NPI:1548217433
Name:SOUTH TEXAS RETINA CONSULTANTS, LLP
Entity Type:Organization
Organization Name:SOUTH TEXAS RETINA CONSULTANTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-993-8510
Mailing Address - Street 1:5540 SARATOGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2953
Mailing Address - Country:US
Mailing Address - Phone:361-993-8510
Mailing Address - Fax:361-993-9184
Practice Address - Street 1:5540 SARATOGA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2953
Practice Address - Country:US
Practice Address - Phone:361-993-8510
Practice Address - Fax:361-993-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5362207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09568501Medicaid
TX0052BMMedicare ID - Type Unspecified