Provider Demographics
NPI:1912192139
Name:RETINA CARE SPECIALISTS PLLC
Entity Type:Organization
Organization Name:RETINA CARE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-624-0099
Mailing Address - Street 1:3399 PGA BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2819
Mailing Address - Country:US
Mailing Address - Phone:561-624-0099
Mailing Address - Fax:561-624-7373
Practice Address - Street 1:3399 PGA BLVD
Practice Address - Street 2:STE 350
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2819
Practice Address - Country:US
Practice Address - Phone:561-624-0099
Practice Address - Fax:561-624-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH986Medicare PIN