Provider Demographics
NPI:1205292463
Name:OPHTHALMOLOGY AND RETINA ASSOCIATES, LLC
Entity type:Organization
Organization Name:OPHTHALMOLOGY AND RETINA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-750-2576
Mailing Address - Street 1:PO BOX 4576
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26504-4576
Mailing Address - Country:US
Mailing Address - Phone:409-750-2576
Mailing Address - Fax:
Practice Address - Street 1:1150 7TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1660
Practice Address - Country:US
Practice Address - Phone:724-852-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454412261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery