Organization
COLUMBIA RETINA CLINIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY CUNDIFF (GENERAL MANAGER)
(573) 449-3846
Entity
Organization
Contact information
Practice address
500 N KEENE ST, SUITE 102, COLUMBIA, MO 65201-8104
(573) 449-3846
(573) 499-1451
Mailing address
500 N KEENE ST, SUITE 102, COLUMBIA, MO 65201-8104
(573) 449-3846
(573) 499-1451
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R5072
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201299708
—
MO
01
—
DH2433
RAILROAD MEDICARE
MO
Enumeration date
03/12/2007
Last updated
09/14/2009
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