Healthcare Provider Details

I. General information

NPI: 1457313868
Provider Name (Legal Business Name): ERIE RETINAL SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST SUITE 201
ERIE PA
16507-1427
US

IV. Provider business mailing address

300 STATE ST SUITE 201
ERIE PA
16507-1427
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-4241
  • Fax:
Mailing address:
  • Phone: 814-456-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMES P DAILEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 814-456-4241