Provider Demographics
NPI:1164683108
Name:EAST CAROLINA RETINA CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:EAST CAROLINA RETINA CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN HOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-758-2402
Mailing Address - Street 1:2501 STANTONSBURG RD
Mailing Address - Street 2:STE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3205
Mailing Address - Country:US
Mailing Address - Phone:252-758-2402
Mailing Address - Fax:252-758-2762
Practice Address - Street 1:2501 STANTONSBURG RD
Practice Address - Street 2:STE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3205
Practice Address - Country:US
Practice Address - Phone:252-758-2402
Practice Address - Fax:252-758-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32591207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty