Provider Demographics
NPI:1245233014
Name:RETINA ASSOCIATES, PC
Entity Type:Organization
Organization Name:RETINA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PELZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-769-9022
Mailing Address - Street 1:8679 CONNECTICUT ST
Mailing Address - Street 2:STE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6383
Mailing Address - Country:US
Mailing Address - Phone:219-769-9022
Mailing Address - Fax:219-769-1918
Practice Address - Street 1:8679 CONNECTICUT ST
Practice Address - Street 2:STE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6383
Practice Address - Country:US
Practice Address - Phone:219-769-9022
Practice Address - Fax:219-769-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100213880Medicaid
IN100213880Medicaid