Provider Demographics
NPI:1538937123
Name:MAIN LINE RETINA
Entity type:Organization
Organization Name:MAIN LINE RETINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-257-1304
Mailing Address - Street 1:249 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4135
Mailing Address - Country:US
Mailing Address - Phone:267-257-1304
Mailing Address - Fax:816-208-0207
Practice Address - Street 1:551 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1419
Practice Address - Country:US
Practice Address - Phone:610-710-2020
Practice Address - Fax:610-710-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty