Provider Demographics
NPI:1568428126
Name:PENNSYLVANIA RETINA SPECIALISTS PC
Entity Type:Organization
Organization Name:PENNSYLVANIA RETINA SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-761-8688
Mailing Address - Street 1:220 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1740
Mailing Address - Country:US
Mailing Address - Phone:717-761-8688
Mailing Address - Fax:717-761-5604
Practice Address - Street 1:220 GRANDVIEW AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1740
Practice Address - Country:US
Practice Address - Phone:717-761-8688
Practice Address - Fax:717-761-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty