Provider Demographics
NPI:1689898868
Name:RETINA ASSOCIATES OF CORAL SPRINGS, P.A.
Entity Type:Organization
Organization Name:RETINA ASSOCIATES OF CORAL SPRINGS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BYNOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-755-4633
Mailing Address - Street 1:1881 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8915
Mailing Address - Country:US
Mailing Address - Phone:954-755-4633
Mailing Address - Fax:954-755-4637
Practice Address - Street 1:1881 N UNIVERSITY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8915
Practice Address - Country:US
Practice Address - Phone:954-755-4633
Practice Address - Fax:954-755-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0600049327207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6520Medicare PIN