Provider Demographics
NPI:1689945990
Name:THE RETINA PARTNERS
Entity Type:Organization
Organization Name:THE RETINA PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAJIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DADGOSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:818-788-9333
Mailing Address - Street 1:16500 VENTURA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2011
Mailing Address - Country:US
Mailing Address - Phone:818-788-9333
Mailing Address - Fax:818-788-9273
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-788-9333
Practice Address - Fax:818-788-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90804207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty