Provider Demographics
NPI:1457670648
Name:THE RETINA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:THE RETINA SURGERY CENTER LLC
Other - Org Name:THE RETINA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-215-3850
Mailing Address - Street 1:22232 17TH AVE SE STE 308
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7425
Mailing Address - Country:US
Mailing Address - Phone:206-215-3850
Mailing Address - Fax:206-215-3870
Practice Address - Street 1:1750 112TH AVE NE STE D050
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3779
Practice Address - Country:US
Practice Address - Phone:206-215-3850
Practice Address - Fax:206-215-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016389Medicaid
WA2016389Medicaid