Provider Demographics
NPI:1780753244
Name:ORELLANA RETINA ASSOCIATES PLLC
Entity type:Organization
Organization Name:ORELLANA RETINA ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-453-1462
Mailing Address - Street 1:3211 ROGERS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3891
Mailing Address - Country:US
Mailing Address - Phone:919-453-1462
Mailing Address - Fax:919-453-1473
Practice Address - Street 1:3211 ROGERS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3891
Practice Address - Country:US
Practice Address - Phone:919-453-1462
Practice Address - Fax:919-453-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2262389EMedicare PIN