{"npi":"1902800758","type":"NPI-2","status":"active","name":{"display":"Retina Consultants, PLLC","other":[],"organization_name":"RETINA CONSULTANTS, PLLC","authorised_official":"Robert Dundervill"},"specialty":{"primary_taxonomy":"207WX0107X","primary_taxonomy_description":"Retina Specialist (Ophthalmology) Physician","slug":"retina-specialist-ophthalmology-physician","schema_org_specialty":null,"all":[{"code":"207W00000X","description":"Ophthalmology Physician","primary":false,"state":"WV","license":"002"},{"code":"207WX0107X","description":"Retina Specialist (Ophthalmology) Physician","primary":true,"state":"WV","license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"331 LAIDLEY ST","city":"CHARLESTON","state":"WV","postal_code":"253011605","country_code":"US","street_2":"STE 301","phone":"3043464400","fax":"3043460704"},{"purpose":"MAILING","street_1":"PO BOX 3970","city":"CHARLESTON","state":"WV","postal_code":"253393970","country_code":"US","phone":"3043464400","fax":"3043460704"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"0008255000","state":"WV","issuer":null},{"type_code":"05","label":"Medicaid","value":"0939668","state":"OH","issuer":null},{"type_code":"05","label":"Medicaid","value":"65927964","state":"KY","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20070911000089","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"WV","pac_id":"3375636178"}]},"enumeration_date":"2005-06-09","last_updated":"2022-07-21","_meta":{"source":"NPPES","snapshot_date":"2022-07-21","doc_url":"https://findmynpi.com/api"}}