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General NPI Number Information
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NPI Number | 1295798924
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Entity Type | Organization
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Legal Business Name | RETINA GROUP OF PENNSYLVANIA, P.C.
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 800 W. FOURTH STREET STE 104
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-7200
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Country | US
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Telephone | 570-321-0880
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Fax | 570-321-8012
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Provider Business Mailing Address
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Address Line | 800 W. FOURTH STREET STE 104
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-7200
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Country | US
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Telephone | 570-321-0880
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Fax | 570-321-8012
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID A LIGHTMAN
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Credential | MD
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Telephone | 570-321-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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