Provider Demographics
NPI:1104229855
Name:RETINA CENTER OF OHIO, LLC
Entity type:Organization
Organization Name:RETINA CENTER OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETROPINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-382-3366
Mailing Address - Street 1:1611 S GREEN RD
Mailing Address - Street 2:SUITE 306B
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4129
Mailing Address - Country:US
Mailing Address - Phone:216-382-3366
Mailing Address - Fax:216-382-4959
Practice Address - Street 1:1161 S. GREEN ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4129
Practice Address - Country:US
Practice Address - Phone:216-382-3366
Practice Address - Fax:216-382-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0806837Medicaid
OH21874635700OtherWORKMAN'S COMP
OHE54245Medicare PIN
OH0806837Medicaid