Provider Demographics
NPI:1639781545
Name:HARBOR RETINA CENTER PLLC
Entity Type:Organization
Organization Name:HARBOR RETINA CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-356-9700
Mailing Address - Street 1:3273 DAVISON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2902
Mailing Address - Country:US
Mailing Address - Phone:810-356-9700
Mailing Address - Fax:810-356-9700
Practice Address - Street 1:3273 DAVISON RD STE 1
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2902
Practice Address - Country:US
Practice Address - Phone:810-356-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty