Organization
RETINA ASSOCIATES, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK M PRUSSIAN MBA, FACHE, COE (ADMINISTRATOR)
(502) 589-1500
Entity
Organization
Contact information
Practice address
1536 STORY AVE, THE EYE CARE INSTITUTE BUILDING, LOUISVILLE, KY 40206-1738
(502) 589-1500
(502) 589-1556
Mailing address
1536 STORY AVE, THE EYE CARE INSTITUTE BUILDING, LOUISVILLE, KY 40206-1738
(502) 589-1500
(502) 589-1556
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1136DT
KY
152W00000X
Optometrist
1613DT
KY
152W00000X
Optometrist
1614DT
KY
207W00000X
Ophthalmology Physician
01040010
IN
207W00000X
Ophthalmology Physician
01043733
IN
207W00000X
Ophthalmology Physician
01043769
IN
207W00000X
Ophthalmology Physician
28590
KY
207W00000X
Ophthalmology Physician
28804
KY
207W00000X
Ophthalmology Physician
Primary
31573
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100221560A
—
IN
01
—
1121048
GROUP PASSPORT NUMBER
KY
05
—
65917502
—
KY
01
—
779033591
GROUP OD MEDICAID NUMBER
KY
01
—
CF7698
GROUP RR MEDICARE NUMBER
KY
Enumeration date
06/14/2005
Last updated
10/15/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us