Provider Demographics
NPI:1194170779
Name:SK RETINA LLC
Entity type:Organization
Organization Name:SK RETINA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-777-5000
Mailing Address - Street 1:1700 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3110
Mailing Address - Country:US
Mailing Address - Phone:941-777-5000
Mailing Address - Fax:941-870-9002
Practice Address - Street 1:1700 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3110
Practice Address - Country:US
Practice Address - Phone:941-777-5000
Practice Address - Fax:941-870-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125837207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty