Retina Institute of Washington PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD60021230 Issued in WA

Legal business name

RETINA INSTITUTE OF WASHINGTON PLLC

Practice address

4300 Talbot Rd S Ste 201
Renton, WA 98055-6238

Phone

(206) 892-8281

NPI assigned

Dec 10, 2009

Organization subpart

No

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

Authorized official

Name

George J. Ko, M.D.

Title

Managing Director

Phone

(425) 228-6262

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280188800000",
    "number": "1578892196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 TALBOT RD S",
            "address_2": "STE 201",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556238",
            "telephone_number": "425-228-6262",
            "fax_number": "425-228-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 TALBOT RD S STE 201",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556238",
            "telephone_number": "206-892-8281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA INSTITUTE OF WASHINGTON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2010-07-27",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "425-228-6262",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD60021230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI-INDIVIDUAL",
            "identifier": "1205890514",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE PROFESSIONAL LICENSE",
            "identifier": "MD60021230",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Renzetti, SUDP/T
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• Cheryl Ann Retic, LMFT
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• Retina Institute, PLLC
• Kreed Revere
• Eunice Margarita Reyes-Diaz, MA
• Reyjines Haven Afh LLC
• Antonio Reyna, MA

• Ophthalmology Physician in Renton, WA
• Providers in Renton, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; 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.