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RETINA MACULA SPECIALISTS PLLC
Complete NPI Record 1134304884
Specialist in Kissimmee, FL

NPI Status: Active since December 31, 2007

Contact Information

720 W OAK ST
SUITE 301
KISSIMMEE, FL
ZIP 34741
Phone: (407) 931-1510
Fax: (407) 931-3759

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Other Provider Identifier 1
  30. Other Provider Identifier Type Code 1
  31. Other Provider Identifier State 1
  32. Other Provider Identifier Issuer 1
  33. Is Organization Subpart
  34. Authorized Official Name Prefix Text
  35. Authorized Official Credential Text
  36. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1134304884. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1134304884
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 720 W OAK ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 301
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: KISSIMMEE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 347414989
The State code in the location of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Mailing Address Telephone Number: 4079311510
The country code in the location address of the provider being identified.
Provider Business Mailing Address Fax Number: 4079313759
The telephone number associated with the location address of the provider being identified.
Provider First Line Business Practice Location Address: 720 W OAK ST
The fax number associated with the location address of the provider being identified.
Provider Second Line Business Practice Location Address: SUITE 301
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address City Name: KISSIMMEE
The date that a record was last updated or changed.
Provider Business Practice Location Address State Name: FL
The code designating the provider’s gender if the provider is a person.
Provider Business Practice Location Address Postal Code: 347414989
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4079311510
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4079313759
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 12/31/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/16/2011
The date that a record was last updated or changed.
Authorized Official Last Name: MEMBRENO
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: JAIME
The first name of the authorized official.
Authorized Official Title or Position: OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 4079311510
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 174400000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: AB492
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: FL
Other Provider Identifier Issuer 1: MDCRE PROVIDER #
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.
Authorized Official Credential Text: M.D.
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP