Provider Demographics
NPI:1710276001
Name:RETINA AND MACULA SPECIALISTS PS
Entity Type:Organization
Organization Name:RETINA AND MACULA SPECIALISTS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-573-0948
Mailing Address - Street 1:2914 S ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4819
Mailing Address - Country:US
Mailing Address - Phone:253-573-0948
Mailing Address - Fax:253-573-0942
Practice Address - Street 1:1107 SW GRADY WAY
Practice Address - Street 2:SUITE 222
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5217
Practice Address - Country:US
Practice Address - Phone:425-255-1999
Practice Address - Fax:425-656-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB27022Medicare PIN