MEDICARE: RETINA CONSULTANTS, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1528181674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CONSULTANTS, LLP

Provider Business Mailing Address
First Line	:	2450 12TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2152
Country	:	US
Telephone Number	:	503-371-4350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 12TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2152
Country	:	US
Telephone Number	:	503-371-4350
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TERI L SHEETS
Credential	:
Telephone Number	:	971-332-1313

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	12/12/2024

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