Provider Demographics
NPI:1295798924
Name:RETINA GROUP OF PENNSYLVANIA, P.C.
Entity type:Organization
Organization Name:RETINA GROUP OF PENNSYLVANIA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-321-0880
Mailing Address - Street 1:800 W. FOURTH STREET
Mailing Address - Street 2:STE 104
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-7200
Mailing Address - Country:US
Mailing Address - Phone:570-321-0880
Mailing Address - Fax:570-321-8012
Practice Address - Street 1:800 W. FOURTH STREET
Practice Address - Street 2:STE 104
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-7200
Practice Address - Country:US
Practice Address - Phone:570-321-0880
Practice Address - Fax:570-321-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017783920003OtherMEDICAID MUNCY
PACG3379OtherRAILRAOD MEDICARE
PAG68788OtherAMERIHEALTH ADMINISTRATOR
PA0005589714OtherAETNA
PA5365OtherGEISINGER HEALTH PLAN
PA1934935OtherUNITED HEALTHCARE
PA0017783920010OtherMEDICAID WILLIAMSPORT
PAS3689OtherEMPIRE BCBS
PA0017783920003OtherMEDICAID DUBOIS
PA001778392Medicaid
PA0017783920002OtherMEDICAID LEWISBURG
PA220491OtherFIRST PRIORITY HEALTH
PA768788OtherBCBS
PA324858OtherHEALTH AMERICA
PA220491OtherFIRST PRIORITY HEALTH