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General NPI Number Information
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NPI Number | 1437105012
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Entity Type | Organization
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Legal Business Name | ROCKFORD RETINA CLINIC, S.C.
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1075 FEATHERSTONE RD STE 10
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City | ROCKFORD
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State | IL
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Zip | 61107-5906
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Country | US
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Telephone | 815-395-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 6785 WEAVER RD STE D
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City | ROCKFORD
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State | IL
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Zip | 61114-8055
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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 | PRESIDENT
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Name | SINA BAHMANYAR
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Credential | MD
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Telephone | 815-395-1157
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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 |
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License Number State |
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