Provider Demographics
NPI:1972705085
Name:THE RETINA CLINIC, LLC
Entity Type:Organization
Organization Name:THE RETINA CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-604-3276
Mailing Address - Street 1:195 ROUTE 46 WEST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 ROUTE 46 WEST
Practice Address - Street 2:SUITE 204
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803
Practice Address - Country:US
Practice Address - Phone:570-604-3276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA1582492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582492Medicaid
1192886758OtherDR. PATEL INDIVIDUAL NPI