Provider Demographics
NPI:1609818913
Name:RETINA ASSOCIATES LLC
Entity Type:Organization
Organization Name:RETINA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-831-7400
Mailing Address - Street 1:8600 QUIVIRA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2857
Mailing Address - Country:US
Mailing Address - Phone:913-831-7400
Mailing Address - Fax:913-831-7409
Practice Address - Street 1:8600 QUIVIRA RD STE 100
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2857
Practice Address - Country:US
Practice Address - Phone:913-831-7400
Practice Address - Fax:913-831-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCB2776OtherRAILROAD MEDICARE
KS100342190AMedicaid
MOCB2777OtherRAILROAD MEDICARE
KS110601OtherBLUE CROSS BLUE SHIELD OF
MO25646013OtherBLUE CROSS BLUE SHIELD OF
MO505323600Medicaid
MOMA3835Medicare PIN
KSCB2776OtherRAILROAD MEDICARE
MO505323600Medicaid