Healthcare Provider Details

I. General information

NPI: 1033735261
Provider Name (Legal Business Name): INFINITY RETINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 LANCASTER AVE STE 210
WAYNE PA
19087-2558
US

IV. Provider business mailing address

851 DUPORTAIL RD STE 200
CHESTERBROOK PA
19087-5577
US

V. Phone/Fax

Practice location:
  • Phone: 484-232-9948
  • Fax: 215-893-4888
Mailing address:
  • Phone: 484-232-9948
  • Fax: 215-893-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: A'SHA MABLE BROWN
Title or Position: OWNER
Credential:
Phone: 484-232-9948