Organization
RIDLEY CREEK RETINA LLC
Active
Organization
RIDLEY CREEK RETINA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON LANGE MD (PRESIDENT)
(610) 892-1708
Entity
Organization
Contact information
Practice address
200 E STATE ST STE 303, MEDIA, PA 19063-3434
(610) 892-1708
(610) 892-8766
Mailing address
200 E STATE ST STE 303, MEDIA, PA 19063-3434
(610) 892-1708
(610) 892-8766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
09/23/2020
Last updated
12/23/2025
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