| Name: | Alabama Retina LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Feb 2016 (9 years ago) (Companies founded in February 2016) |
| Entity Number: | 000-353-777 |
| Register Number: | 000353777 |
| ZIP code: | 36303 (Companies in Houston, 36303) |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 212 W. TROY STREET,SUITE BDOTHAN, AL 36303 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033578901 | 2016-02-19 | 2020-06-07 | 242 WINTON BLOUNT LOOP, MONTGOMERY, AL, 361173501, US | 242 WINTON BLOUNT LOOP, MONTGOMERY, AL, 361173501, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-384-1141 |
Authorized person
| Name | DR. ANDREW HSIA |
| Role | FOUNDER |
| Phone | 3346250884 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | 30073 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207WX0107X - Retina Specialist (Ophthalmology) Physician |
| License Number | 30073 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 119659 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| REGISTERED AGENTS INC | Agent | 212 W. TROY ST. STE BDOTHAN, AL 36303 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
