Provider Demographics
NPI:1437429255
Name:RETINAVUE PC
Entity Type:Organization
Organization Name:RETINAVUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, US REGION & GM RESPIRATORY HTH
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-934-1719
Mailing Address - Street 1:4341 STATE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13153-5300
Mailing Address - Country:US
Mailing Address - Phone:315-291-3539
Mailing Address - Fax:
Practice Address - Street 1:651 S MOUNT JULIET RD # 1014
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6319
Practice Address - Country:US
Practice Address - Phone:315-291-3539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33959207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF53842Medicare UPIN