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General NPI Number Information
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NPI Number | 1528303849
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Entity Type | Organization
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Legal Business Name | RETINA INSTITUTE, PLLC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 4300 TALBOT RD S STE 300
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City | RENTON
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State | WA
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Zip | 98055-6238
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Country | US
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Telephone | 425-228-6262
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Fax | 425-228-6260
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Provider Business Mailing Address
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Address Line | 4300 TALBOT RD S STE 300
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City | RENTON
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State | WA
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Zip | 98055-6238
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Country | US
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Telephone | 425-228-6262
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Fax | 425-228-6260
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | GEORGE J KO
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Credential | M.D.
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Telephone | 425-228-6262
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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 | MD60021230
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License Number State | WA
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