Provider Demographics
NPI:1689604316
Name:RETINA CENTER PA
Entity Type:Organization
Organization Name:RETINA CENTER PA
Other - Org Name:RETINA CENTER OF MINNESOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDHISH
Authorized Official - Middle Name:RAMAN
Authorized Official - Last Name:BHAVSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-871-2292
Mailing Address - Street 1:710 E 24TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3846
Mailing Address - Country:US
Mailing Address - Phone:612-871-2292
Mailing Address - Fax:952-460-5274
Practice Address - Street 1:710 E 24TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3846
Practice Address - Country:US
Practice Address - Phone:612-871-2292
Practice Address - Fax:952-460-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty