MEDICARE: RETINA INSTITUTE OF ARIZONA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician

General Provider Information

NPI Number	:	1316828221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA INSTITUTE OF ARIZONA, PLLC

Provider Business Mailing Address
First Line	:	3303 E BASELINE RD STE 108
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-534-7333
Fax Number	:	480-534-7333

Provider Business Practice Location Address
First Line	:	3303 E BASELINE RD STE 108
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-534-7333
Fax Number	:	480-534-7333

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DAVID TODD GOLDENBERG
Credential	:
Telephone Number	:	480-534-7333

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	03/03/2026

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