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General NPI Number Information
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NPI Number | 1760983563
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Entity Type | Organization
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Legal Business Name | GLOBAL RETINA INSTITUTE LLC
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 4835 E CACTUS RD STE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85254
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Country | US
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Telephone | 480-490-2353
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Fax |
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Provider Business Mailing Address
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Address Line | 4835 E CACTUS RD STE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4192
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Country | US
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Telephone | 480-490-8080
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Fax | 480-534-8081
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBIN DEMI ROSS
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Credential | MD. MPH
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Telephone | 480-534-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 52811
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License Number State | AZ
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