Healthcare Provider Details

I. General information

NPI: 1912991225
Provider Name (Legal Business Name): RETINA ASSOCIATES OF CLEVELAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24075 COMMERCE PARK
BEACHWOOD OH
44122-5846
US

IV. Provider business mailing address

24075 COMMERCE PARK
BEACHWOOD OH
44122-5846
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-5700
  • Fax: 216-831-1959
Mailing address:
  • Phone: 216-831-5700
  • Fax: 216-831-1959

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: NICOLE LAUGHLIN
Title or Position: DIRECTOR OF REVENUE
Credential:
Phone: 216-831-5704