Provider Demographics
NPI:1780765354
Name:RETINA CONSULTANTS INC
Entity type:Organization
Organization Name:RETINA CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-274-5844
Mailing Address - Street 1:101 PLAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4828
Mailing Address - Country:US
Mailing Address - Phone:401-274-5844
Mailing Address - Fax:401-274-9462
Practice Address - Street 1:101 PLAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4828
Practice Address - Country:US
Practice Address - Phone:401-274-5844
Practice Address - Fax:401-274-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9729321Medicaid
RIRC01092Medicaid
MA9729321Medicaid