DEEP BLUE RETINA PLLC NPI 1427511880

NPI Information

DEEP BLUE RETINA, PLLC is a retina specialist ophthalmology in Southaven, MS. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. DEEP BLUE RETINA, PLLC NPI is 1427511880. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7900 AIRWAYS BLVD BLDG A1
SOUTHAVEN, MS
ZIP 38671-116
Phone: (901) 522-6520
Fax: (901) 522-6521

The provider's authorized official is Jorge I Calzada .
The authorized official title is President and has the following contact phone number (901) 522-6520.

The CLIA number assigned to this NPI record is 25D2242140 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/11/2019 and was last updated on 6/28/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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