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General NPI Number Information
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NPI Number | 1083580815
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Entity Type | Organization
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Legal Business Name | FOUR STATES RETINA PLLC
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 5501 MEDICAL PARKWAY DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4624
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Country | US
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Telephone | 804-647-2381
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Fax | 903-204-7745
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Provider Business Mailing Address
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Address Line | 5501 MEDICAL PARKWAY DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4624
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Country | US
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Telephone | 903-204-7642
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Fax | 903-204-7745
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Authorized Official
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Title or Position | OWNER
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Name | ROSHAN GEORGE
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Credential | MD
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Telephone | 903-204-7642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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