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NPI Code Detail

MEDICARE: PENNSYLVANIA RETINA SPECIALISTS PC

MEDICARE: PENNSYLVANIA RETINA SPECIALISTS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

General Provider Information

NPI Number : 1568428126
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENNSYLVANIA RETINA SPECIALISTS PC
Provider Business Mailing Address
First Line : 220 GRANDVIEW AVE
Second Line : SUITE 200
City : CAMP HILL
State : PA
Zip : 17011-1740
Country : US
Telephone Number : 717-761-8688
Fax Number : 717-761-5604
Provider Business Practice Location Address
First Line : 220 GRANDVIEW AVE
Second Line : SUITE 200
City : CAMP HILL
State : PA
Zip : 17011-1740
Country : US
Telephone Number : 717-761-8688
Fax Number : 717-761-5604
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MRS. SUSAN N MARTIN
Credential :
Telephone Number : 717-761-8688
Provider Enumeration Date : 04/24/2006
Last Update Date : 07/07/2020

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Directions to “PENNSYLVANIA RETINA SPECIALISTS PC ” Practice Location

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