Provider Demographics
NPI:1114112125
Name:RETINA CONSULTANTS OF WESTERN NEW YORK, PC
Entity Type:Organization
Organization Name:RETINA CONSULTANTS OF WESTERN NEW YORK, PC
Other - Org Name:RETINA CONSULTANTS OF WESTERN NEW YORK, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-992-7458
Mailing Address - Street 1:6637 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5974
Mailing Address - Country:US
Mailing Address - Phone:716-632-1595
Mailing Address - Fax:716-204-4895
Practice Address - Street 1:6637 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5974
Practice Address - Country:US
Practice Address - Phone:716-632-1595
Practice Address - Fax:716-204-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119187207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty