Provider Demographics
NPI:1528306123
Name:INTELLIGENT RETINA IMAGING SYSTEMS LLC
Entity type:Organization
Organization Name:INTELLIGENT RETINA IMAGING SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-535-2574
Mailing Address - Street 1:418 W GARDEN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-4731
Mailing Address - Country:US
Mailing Address - Phone:888-535-2574
Mailing Address - Fax:
Practice Address - Street 1:418 W GARDEN ST STE 210
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4731
Practice Address - Country:US
Practice Address - Phone:888-535-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty