# THIRD COAST RETINA S.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831823921
- **Authorized official:** CLINTON WARREN MD (PRESIDENT)
- **Authorized official phone:** (262) 420-5888

## Contact information

- **Practice address:** 5017 GREEN BAY RD STE 148, KENOSHA, WI 53144-1782
- **Practice address phone:** (262) 420-5888
- **Mailing address:** 5017 GREEN BAY RD STE 148, KENOSHA, WI 53144-1782
- **Mailing address phone:** (336) 692-3384

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2022
- **Last updated:** 08/10/2022