Provider Demographics
NPI:1215672084
Name:WASHINGTON RETINA, PLLC
Entity type:Organization
Organization Name:WASHINGTON RETINA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-275-1000
Mailing Address - Street 1:125 3RD ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4035
Mailing Address - Country:US
Mailing Address - Phone:253-275-1000
Mailing Address - Fax:253-275-9000
Practice Address - Street 1:125 3RD ST NE STE 200
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4035
Practice Address - Country:US
Practice Address - Phone:253-275-1000
Practice Address - Fax:253-275-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty