Provider Demographics
NPI:1801339429
Name:RETINA GROUP OF OREGON, LLC
Entity type:Organization
Organization Name:RETINA GROUP OF OREGON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:443-604-0348
Mailing Address - Street 1:360 S GARDEN WAY
Mailing Address - Street 2:STE 220
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:775 SW 9TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4895
Practice Address - Country:US
Practice Address - Phone:443-604-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD169541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty