Provider Demographics
NPI:1790733020
Name:RETINA CONSULTANTS OF SOUTHWEST FLORIDA, PA
Entity Type:Organization
Organization Name:RETINA CONSULTANTS OF SOUTHWEST FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-4323
Mailing Address - Street 1:6901 INTERNATIONAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7125
Mailing Address - Country:US
Mailing Address - Phone:239-939-4323
Mailing Address - Fax:239-939-3983
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:239-939-4323
Practice Address - Fax:239-939-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA7010OtherRAILROAD MEDICARE
FL33090CMedicare PIN