Provider Demographics
NPI:1770734451
Name:RETINOVITREOUS ASSOCIATES, LTD
Entity type:Organization
Organization Name:RETINOVITREOUS ASSOCIATES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-233-4300
Mailing Address - Street 1:PO BOX 7780-1600
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:215-233-4300
Mailing Address - Fax:
Practice Address - Street 1:37 MEDICAL CROSSING RD
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-5565
Practice Address - Country:US
Practice Address - Phone:570-386-5926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty