Healthcare Provider Details

I. General information

NPI: 1912192139
Provider Name (Legal Business Name): RETINA CARE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 PGA BLVD STE 350
PALM BEACH GARDENS FL
33410-2819
US

IV. Provider business mailing address

3399 PGA BLVD STE 350
PALM BEACH GARDENS FL
33410-2819
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 Number
License Number StateFL

VIII. Authorized Official

Name: MARK MICHELS
Title or Position: PARTNER
Credential: M.D.
Phone: 561-624-0099