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General NPI Number Information
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NPI Number | 1730233388
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Entity Type | Organization
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Legal Business Name | SUNCOAST RETINA CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 7515 STATE ROAD 52 STE 106
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City | HUDSON
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State | FL
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Zip | 34667-6757
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Country | US
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Telephone | 727-698-4039
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 859
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City | PALM HARBOR
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State | FL
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Zip | 34682-0859
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Country | US
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Telephone | 727-789-8770
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Fax | 727-789-8784
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA M DEUPREE
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Credential | MD
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Telephone | 727-789-8770
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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 | ME58570
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License Number State | FL
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