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General NPI Number Information
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NPI Number | 1528306123
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Entity Type | Organization
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Legal Business Name | INTELLIGENT RETINA IMAGING SYSTEMS LLC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 418 W GARDEN ST STE 210
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City | PENSACOLA
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State | FL
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Zip | 32502-4731
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Country | US
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Telephone | 888-535-2574
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Fax |
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Provider Business Mailing Address
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Address Line | 418 W GARDEN ST STE 210
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City | PENSACOLA
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State | FL
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Zip | 32502-4731
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Country | US
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Telephone | 888-535-2574
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | SUNIL GUPTA
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Credential | MD
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Telephone | 888-535-2574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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