Provider Demographics
NPI:1922006246
Name:RETINA CENTER P A
Entity Type:Organization
Organization Name:RETINA CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PH D
Authorized Official - Phone:979-776-8330
Mailing Address - Street 1:2806 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2601
Mailing Address - Country:US
Mailing Address - Phone:979-776-8330
Mailing Address - Fax:979-774-9157
Practice Address - Street 1:2806 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2601
Practice Address - Country:US
Practice Address - Phone:979-776-8330
Practice Address - Fax:979-774-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2390207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165691001Medicaid
TXDC0989OtherMEDICARE RAILROAD
TX00965WMedicare PIN