Provider Demographics
NPI:1023400058
Name:RETINA CONTRACTING INC
Entity type:Organization
Organization Name:RETINA CONTRACTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLONIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-839-1211
Mailing Address - Street 1:PO BOX 37039
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-1539
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-991-8960
Practice Address - Street 1:4111 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-7609
Practice Address - Country:US
Practice Address - Phone:314-839-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty