Provider Demographics
NPI:1629067673
Name:RETINA ASSOCIATES LTD
Entity Type:Organization
Organization Name:RETINA ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-571-1501
Mailing Address - Street 1:133 E BRUSH HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5659
Mailing Address - Country:US
Mailing Address - Phone:630-571-1501
Mailing Address - Fax:630-571-5679
Practice Address - Street 1:133 E BRUSH HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5659
Practice Address - Country:US
Practice Address - Phone:630-571-1501
Practice Address - Fax:630-571-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060005266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2201714OtherGROUP BCBS OF IL
ILCD1803OtherRR MEDICARE
ILCM7388OtherRR MEDICARE GROUP
IL324810Medicare PIN
IL324811Medicare PIN
IL2201714OtherGROUP BCBS OF IL
ILCD1803OtherRR MEDICARE