MEDICARE: RETINA GLOBAL

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
2	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1972315919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA GLOBAL

Provider Business Mailing Address
First Line	:	PO BOX 8012
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92654-8012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 N TUSTIN AVE STE 200
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3600
Country	:	US
Telephone Number	:	714-494-4085
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	RAJAT AGRAWAL
Credential	:
Telephone Number	:	626-818-9697

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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Directions to “RETINA GLOBAL ” Practice Location

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