Provider Demographics
NPI:1588296610
Name:RETINA FIRST LLC
Entity type:Organization
Organization Name:RETINA FIRST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-922-9571
Mailing Address - Street 1:1502 S MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5374
Mailing Address - Country:US
Mailing Address - Phone:516-922-9571
Mailing Address - Fax:516-922-2288
Practice Address - Street 1:1502 S MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5374
Practice Address - Country:US
Practice Address - Phone:516-922-9571
Practice Address - Fax:516-922-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty