NPIMap

Organization Active NPI

Retina Consultants, LTD

  • Ophthalmology Physician
  • Grand Forks, ND
National Provider Identifier
1649462037
Registry record updated Sep 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
RETINA CONSULTANTS, LTD
Practice address
4350 S Washington St
Suite #112
Grand Forks, ND 58201-7184
Phone
(701) 293-9829
Fax
(701) 293-0111
NPI assigned
Aug 10, 2007
Organization subpart
Yes
Parent organization
RETINA CONSULTANTS, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2017

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

Authorized official

Name
Laurie Polka
Title
Assistant Administrative Manager
Phone
(701) 293-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

4350 S Washington St
Suite #112
Grand Forks, ND 58201-7184

Mailing address

2829 S University Drive
Suite 204
Fargo, ND 58103
Phone (701) 293-9829

National Provider Directory

National Provider Directory
Tax ID family
Retina Consultants LTD2 organizations share this tax ID, including this one
Part of
Retina Consultants LTD

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504742400000",
    "number": "1649462037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 S UNIVERSITY DRIVE",
            "address_2": "SUITE 204",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-293-9829",
            "fax_number": "701-293-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 S WASHINGTON ST",
            "address_2": "SUITE #112",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017184",
            "telephone_number": "701-293-9829",
            "fax_number": "701-293-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA CONSULTANTS, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RETINA CONSULTANTS, LTD",
        "enumeration_date": "2007-08-10",
        "last_updated": "2017-09-07",
        "status": "A",
        "authorized_official_last_name": "POLKA",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "701-293-9829"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; 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.