Healthcare Provider Details

I. General information

NPI: 1639986227
Provider Name (Legal Business Name): ERIE RETINA RESEARCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST STE 302
ERIE PA
16507-1430
US

IV. Provider business mailing address

300 STATE ST STE 302
ERIE PA
16507-1430
US

V. Phone/Fax

Practice location:
  • Phone: 814-200-9152
  • Fax:
Mailing address:
  • Phone: 814-200-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID ALMEIDA
Title or Position: OWNER
Credential: MD
Phone: 814-200-9152