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General NPI Number Information
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NPI Number | 1841135340
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALISTS OF MINNESOTA PLLC
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 3525 PLYMOUTH BLVD STE 207
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City | PLYMOUTH
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State | MN
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Zip | 55447-1384
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Country | US
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Telephone | 617-407-2304
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 PLYMOUTH BLVD STE 207
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City | PLYMOUTH
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State | MN
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Zip | 55447-1384
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | SANDRA R MONTEZUMA
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Credential | MD
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Telephone | 617-407-2304
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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 |
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License Number State |
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