Provider Demographics
NPI:1093748071
Name:RETINA CONSULTANTS PC
Entity Type:Organization
Organization Name:RETINA CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-646-7704
Mailing Address - Street 1:191 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3556
Mailing Address - Country:US
Mailing Address - Phone:860-646-7704
Mailing Address - Fax:860-647-7340
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3556
Practice Address - Country:US
Practice Address - Phone:860-646-7704
Practice Address - Fax:860-647-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01336Medicare PIN