Provider Demographics
NPI:1952867996
Name:RETINA GROUP OF TEXAS, PLLC
Entity Type:Organization
Organization Name:RETINA GROUP OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:INDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-856-5645
Mailing Address - Street 1:13625 RONALD REAGAN BLVD BLDG 9
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2073
Mailing Address - Country:US
Mailing Address - Phone:512-856-5645
Mailing Address - Fax:512-729-6441
Practice Address - Street 1:13625 RONALD REAGAN BLVD BLDG 9
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2073
Practice Address - Country:US
Practice Address - Phone:512-856-5645
Practice Address - Fax:833-703-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty