Provider Demographics
NPI:1033735261
Name:INFINITY RETINA LLC
Entity Type:Organization
Organization Name:INFINITY RETINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:A'SHA
Authorized Official - Middle Name:MABLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-606-1671
Mailing Address - Street 1:100 GRANITE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5134
Mailing Address - Country:US
Mailing Address - Phone:610-606-1671
Mailing Address - Fax:215-893-4888
Practice Address - Street 1:100 GRANITE DR STE 7
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5134
Practice Address - Country:US
Practice Address - Phone:610-606-1671
Practice Address - Fax:215-893-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty