1295798924 NPI number — RETINA GROUP OF PENNSYLVANIA, P.C.

Table of content: (NPI 1295798924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295798924 NPI number — RETINA GROUP OF PENNSYLVANIA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA GROUP OF PENNSYLVANIA, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295798924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W. FOURTH STREET
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-321-0880
Provider Business Mailing Address Fax Number:
570-321-8012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W. FOURTH STREET
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-321-0880
Provider Business Practice Location Address Fax Number:
570-321-8012
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIGHTMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-321-0880

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0017783920003 . This is a "MEDICAID MUNCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CG3379 . This is a "RAILRAOD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G68788 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005589714 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5365 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1934935 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017783920010 . This is a "MEDICAID WILLIAMSPORT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: S3689 . This is a "EMPIRE BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017783920003 . This is a "MEDICAID DUBOIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001778392 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017783920002 . This is a "MEDICAID LEWISBURG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 220491 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 768788 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 324858 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com