Retina Associates PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

6710 Issued in ND

Legal business name

RETINA ASSOCIATES PC

Practice address

4642 Amber Valley Pkwy S
Fargo, ND 58104-8612

Phone

(701) 277-4699

Fax

(701) 277-8357

NPI assigned

Apr 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary Donald Haynie, M.D.

Title

President

Phone

(701) 277-4699

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1104045202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11247",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581061247",
            "telephone_number": "701-277-4699",
            "fax_number": "701-277-8357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4642 AMBER VALLEY PKWY S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048612",
            "telephone_number": "701-277-4699",
            "fax_number": "701-277-8357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "HAYNIE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-277-4699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "ND",
            "license": "6710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11166",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.