MEDICARE: RETINA CONSULTANTS PC

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

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750445425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CONSULTANTS PC

Provider Business Mailing Address
First Line	:	3520 WALTON WAY EXT
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6605
Country	:	US
Telephone Number	:	706-481-9191
Fax Number	:	706-481-9197

Provider Business Practice Location Address
First Line	:	3520 WALTON WAY EXT
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6605
Country	:	US
Telephone Number	:	706-481-9191
Fax Number	:	706-481-9197

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. OKSANA M DEMEDIUK
Credential	:	MD
Telephone Number	:	706-481-9191

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/26/2013

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