# RETINA ASSOCIATES, PSC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Audubon Optical Shop
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679626139
- **Authorized official:** MR. MARK M PRUSSIAN (ADMINISTRATOR)
- **Authorized official phone:** (502) 589-1500

## Contact information

- **Practice address:** 2355 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1395
- **Practice address phone:** (502) 637-3036
- **Practice address fax:** (502) 637-1105
- **Mailing address:** 2355 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1395
- **Mailing address phone:** (502) 637-3036
- **Mailing address fax:** (502) 637-1105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | — | NULL | Yes |
| 156FX1800X | Optician | — | — | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 06/29/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100221560 | — | IN |
| 05 | — | 65917502 | — | KY |