Healthcare Provider Details

I. General information

NPI: 1750477188
Provider Name (Legal Business Name): RETINA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-3500
  • Fax: 540-722-3536
Mailing address:
  • Phone: 540-722-3500
  • Fax: 540-722-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRYSTAL WAUGH
Title or Position: OFFICE MANAGER
Credential:
Phone: 540-722-3500