Provider Demographics
NPI:1013984129
Name:WARREN RETINA ASSOCIATES, PA
Entity Type:Organization
Organization Name:WARREN RETINA ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ADRIAN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-339-6970
Mailing Address - Street 1:12905 WESTGATE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2365
Mailing Address - Country:US
Mailing Address - Phone:913-897-2899
Mailing Address - Fax:913-897-8017
Practice Address - Street 1:10100 W 119TH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1604
Practice Address - Country:US
Practice Address - Phone:913-339-6970
Practice Address - Fax:913-339-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104924OtherBCBS TOPEKA
KS21234042OtherBCBS KANSAS CITY
F48144Medicare UPIN
KS104924Medicare ID - Type UnspecifiedTOPEKA