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General NPI Number Information
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NPI Number | 1477537645
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Entity Type | Organization
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Legal Business Name | RETINA CENTER PA
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6400 W NEWBERRY RD SUITE 301
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City | GAINESVILLE
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State | FL
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Zip | 32605-6605
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Country | US
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Telephone | 352-333-5050
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Fax | 352-248-2228
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Provider Business Mailing Address
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Address Line | 6400 W NEWBERRY RD SUITE 301
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City | GAINESVILLE
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State | FL
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Zip | 32605-6605
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Country | US
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Telephone | 352-333-5050
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Fax | 352-248-2228
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Authorized Official
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Title or Position | DIRECTOR PRESIDENT
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Name | ROBERT NEIL MAMES
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Credential | MD
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Telephone | 352-333-5050
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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 | FL
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