Provider Demographics
NPI:1457313868
Name:ERIE RETINAL SURGERY, INC.
Entity Type:Organization
Organization Name:ERIE RETINAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-4241
Mailing Address - Street 1:300 STATE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1427
Mailing Address - Country:US
Mailing Address - Phone:814-456-4241
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-456-4241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA788719Medicare ID - Type Unspecified