Healthcare Provider Details

I. General information

NPI: 1295811560
Provider Name (Legal Business Name): RETINA ASSOCIATES OF WESTERN NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SAWGRASS DR SUITE 200
ROCHESTER NY
14620-4648
US

IV. Provider business mailing address

160 SAWGRASS DR SUITE 200
ROCHESTER NY
14620-4648
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-3411
  • Fax: 585-340-3747
Mailing address:
  • Phone: 585-442-3411
  • Fax: 585-340-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEVEN J ROSE
Title or Position: PRESIDENT
Credential: MD
Phone: 585-442-3411