Provider Demographics
NPI:1346216801
Name:THE RETINA GROUP OF NORTHEAST OHIO INC
Entity type:Organization
Organization Name:THE RETINA GROUP OF NORTHEAST OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-434-1185
Mailing Address - Street 1:650 GRAHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1052
Mailing Address - Country:US
Mailing Address - Phone:330-434-1185
Mailing Address - Fax:330-434-8533
Practice Address - Street 1:650 GRAHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1052
Practice Address - Country:US
Practice Address - Phone:330-434-1185
Practice Address - Fax:330-434-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9265582OtherMCR
OH0149897Medicaid