Provider Demographics
NPI:1477694743
Name:RETINA GROUP LIMITED PC
Entity Type:Organization
Organization Name:RETINA GROUP LIMITED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-632-8100
Mailing Address - Street 1:PO BOX 503856
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:618-632-8100
Mailing Address - Fax:618-632-8101
Practice Address - Street 1:4550 MEMORIAL DR STE 350
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5372
Practice Address - Country:US
Practice Address - Phone:618-632-8100
Practice Address - Fax:618-632-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094928174400000X
MO105431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5234019OtherAETNA MO
IL06030124OtherBCBSIL
MO143209OtherBCBSMO
IL3411178005OtherCIGNA IL
MO3411178005OtherCIGNA MO
IL000000012366OtherESSENCE
IL10585OtherGHP IL
MOCB6939OtherRRMCRMO GROUP ID
MO008257OtherEXCLUSIVE CHOICE MO
MO000000012366OtherESSENCE MO
IL213418OtherPTAN
ILCB6940OtherRRMCRIL GROUP ID
MO000015461OtherPTAN
MO10585OtherGHP MO
MO255484OtherHEALTHLINK MO
IL255484OtherHLTHLNK
IL008257OtherEXCLU CHOICE IL
IL5234019OtherAETNA IL
MO255484OtherHEALTHLINK MO
MO5234019OtherAETNA MO