NPIMap

Organization Active NPI

Retina Consultants, PLLC

  • Retina Specialist (Ophthalmology) Physician
  • Charleston, WV
National Provider Identifier
1902800758
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
RETINA CONSULTANTS, PLLC
Practice address
331 Laidley St
Ste 301
Charleston, WV 25301-1605
Phone
(304) 346-4400
Fax
(304) 346-0704
NPI assigned
Jun 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Robert Frank Dundervill III, MDNPI 1497759229
Title
Managing Partner
Phone
(304) 346-4400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 002 WV
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X WV Primary

Addresses

Primary practice location

331 Laidley St
Ste 301
Charleston, WV 25301-1605

Mailing address

PO Box 3970
Charleston, WV 25339-3970
Phone (304) 346-4400

Other identifiers 3

IdentifierTypeStateIssuer
0008255000MedicaidWV
0939668MedicaidOH
65927964MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070911000089 WV Part B Supplier - Clinic/Group Practice 3375636178 Receives reassigned benefits from 8 practitioners
Practice locations: Beckley, WV; Charleston, WV; Huntington, WV; Parkersburg, WV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2337894Retina Consultants, PLLC331 Laidley Street, Suite 301, Charleston, WV 25301Certificate of waiverFeb 1, 2028

National Provider Directory

National Provider Directory

Locations

223 George St
Ste 3
Beckley, WV 25801
Phone (304) 252-2558

223 George St
Ste 301
Beckley, WV 25801

223 George St
Beckley, WV 25801

331 Laidley St
Ste 301
Charleston, WV 25301
Phone (304) 346-4400

4421 Emerson Ave
Ste 200
Parkersburg, WV 26104
Phone (304) 346-4400

2502 Jefferson Ave
Pt Pleasant, WV 25550
Phone (304) 812-5941

Practitioners & affiliated clinicians

Practitioners 9

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": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1902800758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3970",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253393970",
            "telephone_number": "304-346-4400",
            "fax_number": "304-346-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 LAIDLEY ST",
            "address_2": "STE 301",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011605",
            "telephone_number": "304-346-4400",
            "fax_number": "304-346-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA CONSULTANTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2022-07-21",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "DUNDERVILL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "304-346-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "WV",
            "license": "002",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008255000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0939668",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65927964",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.