Provider Demographics
NPI:1699846535
Name:MIDWEST RETINA, INC
Entity Type:Organization
Organization Name:MIDWEST RETINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:TURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-339-8500
Mailing Address - Street 1:6655 POST RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8214
Mailing Address - Country:US
Mailing Address - Phone:614-339-8500
Mailing Address - Fax:614-339-8501
Practice Address - Street 1:6655 POST RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8214
Practice Address - Country:US
Practice Address - Phone:614-339-8500
Practice Address - Fax:614-339-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584430Medicaid
OH2322490Medicaid
OH2322516Medicaid
OH2322552Medicaid
OH2584298Medicaid
OH2322525Medicaid
OH9211444Medicare PIN
OH9211443Medicare PIN
OH2322552Medicaid
OH2584298Medicaid
OH2322490Medicaid
OH2584430Medicaid
OH9211448Medicare PIN