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General NPI Number Information
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NPI Number | 1760408397
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Entity Type | Organization
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Legal Business Name | RETINA ASSOCIATES, PLLC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 4414 LAKE BOONE TRL STE 302
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City | RALEIGH
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State | NC
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Zip | 27607-7513
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Country | US
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Telephone | 919-782-8038
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Fax | 919-782-8189
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Provider Business Mailing Address
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Address Line | 4414 LAKE BOONE TRL STE 302
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City | RALEIGH
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State | NC
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Zip | 27607-7514
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Country | US
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Telephone | 919-782-8038
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Fax | 919-782-8189
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL K BENNETT
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Credential | MD
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Telephone | 919-782-8038
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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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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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