Provider Demographics
NPI:1194934323
Name:RETINA SPECIALISTS, P.A.
Entity type:Organization
Organization Name:RETINA SPECIALISTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KUFFEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-991-0500
Mailing Address - Street 1:5656 S STAPLES ST STE 280
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4655
Mailing Address - Country:US
Mailing Address - Phone:361-991-0500
Mailing Address - Fax:361-991-6199
Practice Address - Street 1:5656 S STAPLES ST STE 280
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4655
Practice Address - Country:US
Practice Address - Phone:361-991-0500
Practice Address - Fax:361-991-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079948801Medicaid
TX00129KMedicare ID - Type Unspecified
TX079948801Medicaid