Provider Demographics
NPI:1659971620
Name:MISSOURI RETINA CONSULTANTS PC
Entity Type:Organization
Organization Name:MISSOURI RETINA CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARI
Authorized Official - Middle Name:ANN ZEILER
Authorized Official - Last Name:KEITHAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-777-8738
Mailing Address - Street 1:105 N KEENE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8131
Mailing Address - Country:US
Mailing Address - Phone:573-777-8738
Mailing Address - Fax:573-777-8739
Practice Address - Street 1:105 N KEENE ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8131
Practice Address - Country:US
Practice Address - Phone:573-777-8738
Practice Address - Fax:573-777-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty