Provider Demographics
NPI:1982797007
Name:RETINA PHYSICIANS & SURGEONS, INC.
Entity Type:Organization
Organization Name:RETINA PHYSICIANS & SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-3741
Mailing Address - Street 1:89 SYLVANIA DR
Mailing Address - Street 2:2ND FL
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-427-8900
Mailing Address - Fax:937-427-1710
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:2ND FL
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-427-8900
Practice Address - Fax:937-427-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817718Medicaid
C10064Medicare PIN
OH9243091Medicare PIN