Provider Demographics
NPI:1346354214
Name:RETINA CONSULTANTS OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:RETINA CONSULTANTS OF NORTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-479-2661
Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:FLOOR E
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-479-6181
Mailing Address - Fax:419-479-2664
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:FLOOR E
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-479-6181
Practice Address - Fax:419-479-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1804606472OtherBCBS MI BLUE PREFERRED
OH0900234Medicaid
MI1804606471OtherBCBS-MI PPO TRUST
MI1804646652OtherBCBS MI POINT OF SERVICE
MI1804646651OtherBCBS-MI PPO
MI1804606472OtherBCBS MI POINT OF SERVICE
OHC30500OtherRAILROAD MEDICARE
MI1804646652OtherBCBS MI POINT OF SERVICE
OHC30500OtherRAILROAD MEDICARE