Provider Demographics
NPI:1194708719
Name:RETINA CONSULTANTS OF CAROLINA, PA
Entity type:Organization
Organization Name:RETINA CONSULTANTS OF CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-233-5722
Mailing Address - Street 1:1126 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4620
Mailing Address - Country:US
Mailing Address - Phone:864-233-5722
Mailing Address - Fax:864-233-6027
Practice Address - Street 1:1126 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4620
Practice Address - Country:US
Practice Address - Phone:864-233-5722
Practice Address - Fax:864-233-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty