Provider Demographics
NPI:1558785725
Name:LANCASTER RETINA SPECIALISTS PC
Entity Type:Organization
Organization Name:LANCASTER RETINA SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-399-8790
Mailing Address - Street 1:2150 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-399-8790
Mailing Address - Fax:717-399-3279
Practice Address - Street 1:2150 HARRISBURG PIKE
Practice Address - Street 2:SUITE 370
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-399-8790
Practice Address - Fax:717-399-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039715L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty