Healthcare Provider Details

I. General information

NPI: 1588794200
Provider Name (Legal Business Name): RETINA GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 NEIL AVE STE 220
COLUMBUS OH
43215-7310
US

IV. Provider business mailing address

262 NEIL AVE STE 220
COLUMBUS OH
43215-7310
US

V. Phone/Fax

Practice location:
  • Phone: 614-464-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICKOLE DELANEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 614-464-3937