Estero Retina

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME105560 Issued in FL

Legal business name

ESTERO RETINA

Practice address

9500 Corkscrew Palms Cir
Estero, FL 33928-3307

Phone

(321) 222-3937

NPI assigned

Sep 12, 2014

Last updated

Sep 12, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Karla Kellam

Title

Administrator

Phone

(904) 713-2126

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1932500634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8951 BONITA BEACH RD SE STE 525-298",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354201",
            "telephone_number": "321-222-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 CORKSCREW PALMS CIR",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339283307",
            "telephone_number": "321-222-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTERO RETINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-12",
        "last_updated": "2014-09-12",
        "status": "A",
        "authorized_official_last_name": "KELLAM",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-713-2126",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME105560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Estero Bay Dental, PLLC
• Estero Dermatology & Skin Surgery Center, LLC (Houck Dermatology)
• Estero Eyecare
• Estero Family Chiropractic LLC
• Estero General Dentistry LLC (Coastal Smiles)
• Estero Smiles Dentistry, PA (Estero Smiles Dentistry)
• Ernesto Alberto Eusebio Morales, M.D.
• Evolv Behavior, LLC
• Elyse Dyan Ewig, AUD
• Eye Doctors Optical Outlets

• Ophthalmology Physician in Estero, FL
• Providers in Estero, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.