MEDICARE: RETINA ASSOCIATES PA

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	207W00000X	Ophthalmology Physician	ME0053221	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	180005784	OTHER		RAILROAD MEDICARE
5	C12098	OTHER		RAILROAD MEDICARE
6	18BDCCP	OTHER	GA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	05860	OTHER	FL	BLUE CROSS/BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619958352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA ASSOCIATES PA

Provider Business Mailing Address
First Line	:	751 OAK ST STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3376
Country	:	US
Telephone Number	:	904-388-8446
Fax Number	:	904-384-6261

Provider Business Practice Location Address
First Line	:	751 OAK ST STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3376
Country	:	US
Telephone Number	:	904-388-8446
Fax Number	:	904-384-6261

Authorized Official
Title or Position	:	MD
Name	:	MANSOOR S. MUGHAL
Credential	:
Telephone Number	:	904-388-8446

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	02/10/2026

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Directions to “RETINA ASSOCIATES PA ” Practice Location

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