Healthcare Provider Details

I. General information

NPI: 1346216801
Provider Name (Legal Business Name): THE RETINA GROUP OF NORTHEAST OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 GRAHAM RD SUITE 103
CUYAHOGA FALLS OH
44221-1052
US

IV. Provider business mailing address

650 GRAHAM RD SUITE 103
CUYAHOGA FALLS OH
44221-1052
US

V. Phone/Fax

Practice location:
  • Phone: 330-434-1185
  • Fax: 330-434-8533
Mailing address:
  • Phone: 330-434-1185
  • Fax: 330-434-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA L BECKETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-434-1185