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General NPI Number Information
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NPI Number | 1437429255
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Entity Type | Organization
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Legal Business Name | RETINAVUE PC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 651 S MOUNT JULIET RD # 1014
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City | MOUNT JULIET
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State | TN
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Zip | 37122-6319
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Country | US
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Telephone | 315-291-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 4341 STATE STREET RD
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City | SKANEATELES FALLS
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State | NY
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Zip | 13153-5300
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Country | US
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Telephone | 315-291-3539
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Fax |
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Authorized Official
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Title or Position | VP, US REGION & GM RESPIRATORY HTH
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Name | JAMES C. O'CONNELL
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Credential |
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Telephone | 812-934-1719
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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 | 33959
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License Number State | TN
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