Provider Demographics
NPI:1043279300
Name:THE RETINA CARE CENTER
Entity Type:Organization
Organization Name:THE RETINA CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-377-7611
Mailing Address - Street 1:6115 FALLS RD
Mailing Address - Street 2:300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2219
Mailing Address - Country:US
Mailing Address - Phone:410-377-7611
Mailing Address - Fax:410-377-8221
Practice Address - Street 1:6115 FALLS RD
Practice Address - Street 2:300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2219
Practice Address - Country:US
Practice Address - Phone:410-377-7611
Practice Address - Fax:410-377-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051444207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD715601400Medicaid
PA0018913080002Medicaid
MDDA1958Medicare PIN
MD879LMedicare ID - Type Unspecified
PACG5968Medicare PIN
MD180033878Medicare PIN
PACG9799Medicare PIN
PA0018913080002Medicaid