Provider Demographics
NPI:1215437439
Name:NATIONAL RETINA INSTITUTE
Entity type:Organization
Organization Name:NATIONAL RETINA INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-850-0840
Mailing Address - Street 1:88 HARDEES DR
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7062
Mailing Address - Country:US
Mailing Address - Phone:570-850-0840
Mailing Address - Fax:
Practice Address - Street 1:66 ENTERPRISE BLVD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:PA
Practice Address - Zip Code:17810-9260
Practice Address - Country:US
Practice Address - Phone:800-311-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty