Retina Associates of Missouri, P.C.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

MD108058 Issued in MO

Legal business name

RETINA ASSOCIATES OF MISSOURI, P.C.

Practice address

3600 Amron CT
Columbia, MO 65202-1918

Phone

(573) 874-1616

Fax

(573) 875-0300

NPI assigned

Nov 30, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Jerry R Blair, M.D.NPI 1790769701

Title

President

Phone

(573) 874-1616

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry R Blair, M.D., PH.D.

  • Ophthalmology Physician
  • Columbia, MO
  • NPI 1790769701
  Medicare reassignment NPD Authorized official
• Wayne Earl Davis, DO

  • Ophthalmology Physician
  • Columbia, MO
  • NPI 1265663017
  Medicare reassignment Care Compare group NPD
• Clint W Kellogg, D.O.

  • Retina Specialist (Ophthalmology) Physician
  • Columbia, MO
  • NPI 1477998839

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Henry Kell Yang, MD

  • Ophthalmology Physician
  • Columbia, MO
  • NPI 1528049509
  NPD (past)

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1144204553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 AMRON CT",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652021918",
            "telephone_number": "573-874-1616",
            "fax_number": "573-875-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 AMRON CT",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652021918",
            "telephone_number": "573-874-1616",
            "fax_number": "573-875-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA ASSOCIATES OF MISSOURI, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-30",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-874-1616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MO",
            "license": "MD108058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant John Ressel, D.D.S.
• Restoration Chiropractic LLC
• Restoration Eyecare LLC
• Restore Balance Integrative Wellness
• Retina Associates of Mid Missouri, LLC
• Beth R Reule, RD, CSP, LD
• Carin E Reust, MD
• Sara Revelle, FNP
• Revive Rehab, LLC
• Tatiana Arielle Reyes

• Retina Specialist (Ophthalmology) Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Retina Specialist (Ophthalmology) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.