Surgeon Practice

Physician Contact and Surgery Practice Information

RMLEB is making an effort to review and update our contacts at surgery centers and surgeon practices so we can better serve you. Completing the form will ensure you and your employees receive relevant and timely communication related to tissue requests and scheduling, post-surgery follow-up, billing, and events and learning opportunities that may be of interest to you.

If you have any questions about this form, please do not hesitate to contact us at 720-848-3940 or via email at info@corneas.org. Thank you for taking the time to help us improve our services.

     * If your practice has more than 4 surgeons who use tissue from RMLEB, please contact us at info@corneas.org.
 

Name of Physician Practice * Main Practice Address 1 * Main Practice Address 2 City* State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Main Telephone Number * After Hours Phone * Fax Number General Email Address * How many surgeons in your practice use ocular tissues from RMLEB? 1 2 3 4 Surgeon's First Name * Surgeon's Last Name * Credential* MD DO PhD non-USA credential Email for important updates to EBAA and FDA medical standards, eye bank policies, tissue recalls, and other RMLEB communications * Mobile Phone Number * Office Phone * Surgeon's First Name Surgeon's Last Name Credential MD DO PhD non-USA credential Email for important updates to EBAA and FDA medical standards, eye bank policies, tissue recalls, and other RMLEB communications Mobile Phone Number Office Phone Surgeon's First Name Surgeon's Last Name Credential MD DO PhD non-USA credential Email for important updates to EBAA and FDA medical standards, eye bank policies, tissue recalls, and other RMLEB communications Mobile Phone Number Office Phone Surgeon's First Name Surgeon's Last Name Credential MD DO PhD non-USA credential Email for important updates to EBAA and FDA medical standards, eye bank policies, tissue recalls, and other RMLEB communications Mobile Phone Number Office Phone The office has no designated business manager outside of the physician(s) Office/Business Manager First Name Office/Business Manager Last Name Office Phone Office/Business Manager Email Submit