# SUNIL GUPTA MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Retina Specialty Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588610075
- **Authorized official:** DR. SUNIL GUPTA M.D. (MANAGING MEMBER)
- **Authorized official phone:** (850) 476-6759

## Contact information

- **Practice address:** 5150 N DAVIS HWY, PENSACOLA, FL 32503-2030
- **Practice address phone:** (850) 476-6759
- **Practice address fax:** (850) 484-5222
- **Mailing address:** 5150 N DAVIS HWY, PENSACOLA, FL 32503-2030
- **Mailing address phone:** (850) 476-6759
- **Mailing address fax:** (850) 484-5222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME66379 | FL | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 08/31/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 07331062 | MEDICAID | MS |
| 05 | — | 09016091 | — | MS |
| 05 | — | 267921300 | — | FL |
| 01 | — | 34843 | BLUE CROSS PROVIDER GROUP | FL |
| 05 | — | 529917080 | — | AL |