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General NPI Number Information
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NPI Number | 1306379219
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Entity Type | Organization
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Legal Business Name | PERSONALIZED RETINA CARE OF NAPLES
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 3467 PINE RIDGE RD STE 103
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City | NAPLES
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State | FL
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Zip | 34109-3832
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Country | US
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Telephone | 239-325-3960
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Fax |
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Provider Business Mailing Address
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Address Line | 3467 PINE RIDGE RD SUITE 103
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City | NAPLES
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State | FL
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Zip | 34109-3832
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Country | US
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Telephone | 239-325-3970
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Fax | 239-325-3971
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Authorized Official
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Title or Position | OWNER
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Name | KATIA E. TABA
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Credential | MD
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Telephone | 239-325-3970
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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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