=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922006246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RETINA CENTER P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 08/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2806 E 29TH ST
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77802-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-776-8330
-----------------------------------------------------
Fax | 979-774-9157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2806 E 29TH ST
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77802-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-776-8330
-----------------------------------------------------
Fax | 979-774-9157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DEREK PETER KUHL
-----------------------------------------------------
Credential | M.D., PH D
-----------------------------------------------------
Telephone | 979-776-8330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | L2390
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------