Third Coast Retina S.C.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

THIRD COAST RETINA S.C.

Practice address

5017 Green Bay Rd Ste 148
Kenosha, WI 53144-1782

Phone

(262) 420-5888

NPI assigned

Jul 13, 2022

Organization subpart

No

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

Authorized official

Name

Clinton Warren, MDNPI 1902162076

Title

President

Phone

(262) 420-5888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

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

• Clinton Charles Warren, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Kenosha, WI
  • NPI 1902162076
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1831823921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 GREEN BAY RD STE 148",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441782",
            "telephone_number": "336-692-3384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5017 GREEN BAY RD STE 148",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441782",
            "telephone_number": "262-420-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD COAST RETINA S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-420-5888",
        "authorized_official_credential": "MD"
    },
    "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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• Thomas Eye Care S.C.
• Jeffrey R Thomas, O.D,
• Paige H Thomas, APNP
• Sheila D Thomas, CPHT, BSW, MSW, APSW
• Christine Yvonne Thompson-Newby, OT

• Retina Specialist (Ophthalmology) Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Retina Specialist (Ophthalmology) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.