# RETINA VITREOUS OF PA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851112676
- **Authorized official:** DR. AJEY SHASHIKANT ALURKAR MD (DIRECTOR OF RETINA SERVICE)
- **Authorized official phone:** (570) 587-7500

## Contact information

- **Practice address:** 210 N STATE ST STE 3, CLARKS SUMMIT, PA 18411-1008
- **Practice address phone:** (570) 587-7500
- **Mailing address:** 210 N STATE ST, SUITE 1, 3 AND 5 ., CLARKS SUMMIT, PA 18411-1008
- **Mailing address phone:** (570) 587-7500
- **Mailing address fax:** (570) 587-7501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/23/2024
- **Last updated:** 04/08/2025