Provider Demographics
NPI:1659326452
Name:RETINOVITREOUS ASSOCIATES LTD
Entity Type:Organization
Organization Name:RETINOVITREOUS ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CERETELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-331-6634
Mailing Address - Street 1:4060 BUTLER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1560
Mailing Address - Country:US
Mailing Address - Phone:800-331-6634
Mailing Address - Fax:267-420-1362
Practice Address - Street 1:4060 BUTLER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1560
Practice Address - Country:US
Practice Address - Phone:800-331-6634
Practice Address - Fax:267-420-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101472321Medicaid
PA068120Medicare ID - Type UnspecifiedPA MEDICARE