Retina Associates of Mid Missouri, LLC

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

RETINA ASSOCIATES OF MID MISSOURI, LLC

Practice address

11501 E Vemers Ford Rd
Columbia, MO 65201-7465

Phone

(573) 228-0959

NPI assigned

Jan 22, 2021

Organization subpart

No

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

Authorized official

Name

Jerry R Blair, MD, PHDNPI 1790769701

Title

Physician

Phone

(573) 874-1616

Specialties & licenses 1

Addresses

Practitioners 1

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

  Retina Specialist

  NPD Authorized official

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1235729377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11501 E VEMERS FORD RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652017465",
            "telephone_number": "573-228-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11501 E VEMERS FORD RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652017465",
            "telephone_number": "573-228-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA ASSOCIATES OF MID MISSOURI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "573-874-1616",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Jan 22, 2021; 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.