Healthcare Provider Details

I. General information

NPI: 1871534719
Provider Name (Legal Business Name): RETINA CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 PGA BLVD STE 350
PALM BEACH GARDENS FL
33410
US

IV. Provider business mailing address

3399 PGA BLVD STE 350
PALM BEACH GARDENS FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-624-0099
  • Fax: 561-624-7373
Mailing address:
  • Phone: 561-624-0099
  • Fax: 561-624-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME87171
License Number StateFL

VIII. Authorized Official

Name: DR. MARK MICHELS
Title or Position: PRESIDENT
Credential: MD
Phone: 561-624-0099