Healthcare Provider Details

I. General information

NPI: 1194170779
Provider Name (Legal Business Name): SK RETINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TUTTLE AVE
SARASOTA FL
34239-3110
US

IV. Provider business mailing address

1700 S TUTTLE AVE
SARASOTA FL
34239-3110
US

V. Phone/Fax

Practice location:
  • Phone: 941-777-5000
  • Fax: 941-870-9002
Mailing address:
  • Phone: 941-777-5000
  • Fax: 941-870-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME125837
License Number StateFL

VIII. Authorized Official

Name: MARK KIGER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 941-777-5000