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General NPI Number Information
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NPI Number | 1164852075
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Entity Type | Organization
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Legal Business Name | REGIONAL RETINA AND MACULA, LLC
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 330 N CHESTNUT ST
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City | RAVENNA
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State | OH
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Zip | 44266-2287
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Country | US
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Telephone | 503-901-1531
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N CHESTNUT ST
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City | RAVENNA
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State | OH
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Zip | 44266-2287
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | PAUL A KURZ
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Credential |
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Telephone | 503-901-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35083570
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License Number State | OH
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