Provider Demographics
NPI:1497080907
Name:RETINA MACULA EYE CARE, P.C.
Entity Type:Organization
Organization Name:RETINA MACULA EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:TIMOTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-935-5550
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:SUITE 592, VILLAGE SHOPPES
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-989-4744
Mailing Address - Fax:781-769-4794
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:SUITE 592, VILLAGE SHOPPES
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-989-4744
Practice Address - Fax:781-769-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty