Organization
RETINA MACULA SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAIME MEMBRENO M.D. (OWNER)
(407) 931-1510
Entity
Organization
Contact information
Practice address
720 W OAK ST, SUITE 301, KISSIMMEE, FL 34741-4989
(407) 931-1510
(407) 931-3759
Mailing address
720 W OAK ST, SUITE 301, KISSIMMEE, FL 34741-4989
(407) 931-1510
(407) 931-3759
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AB492
MDCRE PROVIDER #
FL
Enumeration date
12/31/2007
Last updated
02/16/2011
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