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General NPI Number Information
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NPI Number | 1609818913
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Entity Type | Organization
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Legal Business Name | RETINA ASSOCIATES LLC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 8600 QUIVIRA RD STE 100
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City | LENEXA
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State | KS
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Zip | 66215-2857
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Country | US
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Telephone | 913-831-7400
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Fax | 913-831-7409
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Provider Business Mailing Address
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Address Line | 8600 QUIVIRA RD STE 100
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City | LENEXA
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State | KS
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Zip | 66215-2857
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Country | US
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Telephone | 913-831-7400
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Fax | 913-831-7409
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLAKE A COOPER
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Credential | MD
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Telephone | 913-831-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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