Provider Demographics
NPI:1841410685
Name:RETINA ASSOCIATES INC
Entity Type:Organization
Organization Name:RETINA ASSOCIATES INC
Other - Org Name:SCHEPENS RETINA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL AND BUSINESS O
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-632-7776
Mailing Address - Street 1:1 AUTUMN STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-632-7777
Mailing Address - Fax:617-632-7770
Practice Address - Street 1:1 AUTUMN ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-7777
Practice Address - Fax:617-632-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty