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General NPI Number Information
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NPI Number | 1902004427
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALISTS PLLC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 527 MEDICAL PARK DR STE 205
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9009
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Country | US
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Telephone | 304-933-3860
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Fax | 304-933-3861
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Provider Business Mailing Address
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Address Line | 527 MEDICAL PARK DR STE 205
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9009
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Country | US
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Telephone | 304-685-1207
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE CONDAX
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Credential | M.D.
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Telephone | 304-685-1207
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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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