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General NPI Number Information
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NPI Number | 1750445425
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Entity Type | Organization
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Legal Business Name | RETINA CONSULTANTS PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 3520 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30909-6605
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Country | US
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Telephone | 706-481-9191
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Fax | 706-481-9197
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Provider Business Mailing Address
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Address Line | 3520 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30909-6605
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Country | US
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Telephone | 706-481-9191
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Fax | 706-481-9197
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. OKSANA M DEMEDIUK
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Credential | MD
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Telephone | 706-481-9191
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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 |
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