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THE RETINA GROUP OF WASHINGTON, PLLC
Complete NPI Record 1568201416
Optometrist in Havre De Grace, MD

NPI Status: Active since May 21, 2024

Contact Information

2023 PULASKI HWY
HAVRE DE GRACE, MD
ZIP 21078
Phone: (410) 939-6477

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Middle Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Healthcare Provider Primary Taxonomy Switch 2
  27. Is Organization Subpart
  28. Parent Organization LBN
  29. Parent Organization TIN
  30. Authorized Official Credential Text
  31. Healthcare Provider Taxonomy Group 1
  32. Healthcare Provider Taxonomy Group 2
  33. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1568201416. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1568201416
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider First Line Business Mailing Address: 420 MOUNTAIN AVE FL 4
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Mailing Address City Name: NEW PROVIDENCE
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Business Mailing Address State Name: NJ
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address Postal Code: 079742736
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address Country Code If outside U S : US
The city name in the mailing address of the provider being identified.
Provider First Line Business Practice Location Address: 2023 PULASKI HWY
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Practice Location Address City Name: HAVRE DE GRACE
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Practice Location Address State Name: MD
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address Postal Code: 210782137
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Practice Location Address Country Code If outside U S : US
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Practice Location Address Telephone Number: 4109396477
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Enumeration Date: 5/21/2024
The country code in the location address of the provider being identified.
Last Update Date: 5/21/2024
The telephone number associated with the location address of the provider being identified.
Authorized Official Last Name: MADREPERLA
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official First Name: STEVEN
The date that a record was last updated or changed.
Authorized Official Middle Name: A
The code designating the provider’s gender if the provider is a person.
Authorized Official Title or Position: PRESIDENT AND CEO
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Authorized Official Telephone Number: 9084588333
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Healthcare Provider Taxonomy Code 1: 152W00000X
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 207W00000X
Healthcare Provider Primary Taxonomy Switch 2: N
Is Organization Subpart: Y
Parent Organization LBN: THE RETINA GROUP OF WASHINGTON, PLLC
Parent Organization TIN: UNAVAIL
Authorized Official Credential Text: MD, PHD
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 5/21/2024