Basic Information
| Provider Information | |||||||||
| NPI: | 1023400058 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RETINA CONTRACTING INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37039 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631411539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144322580 | ||||||||
| FaxNumber: | 3149918960 | ||||||||
| Practice Location | |||||||||
| Address1: | 4111 N ILLINOIS ST | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622267609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148391211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2015 | ||||||||
| LastUpdateDate: | 01/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | DUDNEY | ||||||||
| AuthorizedOfficialFirstName: | BLONIE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3148391211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.