Provider Demographics
NPI:1962427955
Name:SARASOTA RETINA INSTITUTE P A
Entity type:Organization
Organization Name:SARASOTA RETINA INSTITUTE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-921-5335
Mailing Address - Street 1:3400 BEE RIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-921-5335
Mailing Address - Fax:941-921-1741
Practice Address - Street 1:3400 BEE RIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-921-5335
Practice Address - Fax:941-921-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268606600Medicaid
FL98111Medicare PIN
FL268606600Medicaid