Provider Demographics
NPI:1740383827
Name:RETINA CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:RETINA CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-668-3161
Mailing Address - Street 1:1000 VANN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6055
Mailing Address - Country:US
Mailing Address - Phone:731-668-3161
Mailing Address - Fax:731-668-3162
Practice Address - Street 1:1000 VANN DR
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6055
Practice Address - Country:US
Practice Address - Phone:731-668-3161
Practice Address - Fax:731-668-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDG2147OtherRAILROAD MEDICARE
TNDG2147OtherRAILROAD MEDICARE
TN3710768Medicare PIN