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General NPI Number Information
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NPI Number | 1427511880
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Entity Type | Organization
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Legal Business Name | DEEP BLUE RETINA, PLLC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 7900 AIRWAYS BLVD BLDG A1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4116
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Country | US
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Telephone | 901-522-6520
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Fax | 901-522-6521
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Provider Business Mailing Address
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Address Line | 7900 AIRWAYS BLVD BLDG A1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4116
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Country | US
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Telephone | 901-522-6520
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Fax | 901-522-6521
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE I CALZADA
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Credential | MD
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Telephone | 901-522-6520
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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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