Provider Demographics
NPI:1184677510
Name:RETINA SPECIALISTS, PC
Entity Type:Organization
Organization Name:RETINA SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-410-5555
Mailing Address - Street 1:508 BAYLOR CT
Mailing Address - Street 2:STE. A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3680
Mailing Address - Country:US
Mailing Address - Phone:757-410-5555
Mailing Address - Fax:757-410-5875
Practice Address - Street 1:508 BAYLOR CT
Practice Address - Street 2:STE. A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3680
Practice Address - Country:US
Practice Address - Phone:757-410-5555
Practice Address - Fax:757-410-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08579Medicare ID - Type UnspecifiedGROUP NUMBER