Healthcare Provider Details

I. General information

NPI: 1477537645
Provider Name (Legal Business Name): RETINA CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W NEWBERRY RD SUITE 301
GAINESVILLE FL
32605-6605
US

IV. Provider business mailing address

6400 W NEWBERRY RD SUITE 301
GAINESVILLE FL
32605-6605
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5050
  • Fax: 352-248-2228
Mailing address:
  • Phone: 352-333-5050
  • Fax: 352-248-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: ROBERT NEIL MAMES
Title or Position: DIRECTOR PRESIDENT
Credential: MD
Phone: 352-333-5050