Healthcare Provider Details

I. General information

NPI: 1750445425
Provider Name (Legal Business Name): RETINA CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 WALTON WAY EXT
AUGUSTA GA
30909-6605
US

IV. Provider business mailing address

3520 WALTON WAY EXT
AUGUSTA GA
30909-6605
US

V. Phone/Fax

Practice location:
  • Phone: 706-481-9191
  • Fax: 706-481-9197
Mailing address:
  • Phone: 706-481-9191
  • Fax: 706-481-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. OKSANA M DEMEDIUK
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 706-481-9191