Provider Demographics
NPI:1700175395
Name:RETINA CONSULTANTS, LTD
Entity Type:Organization
Organization Name:RETINA CONSULTANTS, LTD
Other - Org Name:THE RETINA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-367-1181
Mailing Address - Street 1:2201 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1870
Mailing Address - Country:US
Mailing Address - Phone:314-367-1181
Mailing Address - Fax:314-968-5117
Practice Address - Street 1:17 THE BOULEVARD SAINT LOUIS
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1118
Practice Address - Country:US
Practice Address - Phone:314-367-1181
Practice Address - Fax:314-968-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty