Provider Demographics
NPI:1942581715
Name:RETINA ASSOCIATES, PSC
Entity Type:Organization
Organization Name:RETINA ASSOCIATES, PSC
Other - Org Name:THE EYE CARE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-589-1500
Mailing Address - Street 1:1536 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1738
Mailing Address - Country:US
Mailing Address - Phone:502-589-1500
Mailing Address - Fax:502-589-1556
Practice Address - Street 1:10731 HWY 44 E
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047
Practice Address - Country:US
Practice Address - Phone:502-589-1500
Practice Address - Fax:502-589-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty