Provider Demographics
NPI:1760408397
Name:RETINA ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:RETINA ASSOCIATES, PLLC
Other - Org Name:NORTH CAROLINA RETINA ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-8038
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7514
Mailing Address - Country:US
Mailing Address - Phone:919-782-8038
Mailing Address - Fax:919-782-8189
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:STE 302
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-782-8038
Practice Address - Fax:919-782-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014T8OtherBCBS-GROUP
NC2333843OtherMEDICARE-GROUP
NCDB4007OtherRR MEDICARE-GROUP
NC89014T8Medicaid
NC89014T8Medicaid