Healthcare Provider Details

I. General information

NPI: 1952552630
Provider Name (Legal Business Name): RETINOVITREOUS ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 CONCORD PIKE STE 101
WILMINGTON DE
19803-3653
US

IV. Provider business mailing address

4060 BUTLER PIKE SUITE 200
PLYMOUTH MEETING PA
19462-1560
US

V. Phone/Fax

Practice location:
  • Phone: 302-351-1087
  • Fax: 302-351-1088
Mailing address:
  • Phone: 800-331-6634
  • Fax: 267-420-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY SHEPPARD
Title or Position: CAO/CFO
Credential:
Phone: 800-331-6634