Provider Demographics
NPI:1700402401
Name:RETINAL RECOVERY LLC
Entity Type:Organization
Organization Name:RETINAL RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-750-7390
Mailing Address - Street 1:9036 S CAROLLTON DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4128
Mailing Address - Country:US
Mailing Address - Phone:414-750-7390
Mailing Address - Fax:
Practice Address - Street 1:9036 S CAROLLTON DR
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4128
Practice Address - Country:US
Practice Address - Phone:414-301-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment