Healthcare Provider Details

I. General information

NPI: 1194725408
Provider Name (Legal Business Name): RETINA AND DIABETIC EYE SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 N. BROADWAY
PENNSVILLE NJ
08070-1754
US

IV. Provider business mailing address

130 STATE ROAD SUITE 206
SPRINGFIELD PA
19064-1232
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-4900
  • Fax: 610-690-1659
Mailing address:
  • Phone: 610-690-4900
  • Fax: 610-690-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ANGELO VACIRCA
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 610-690-4900