Organization
RETINA ASSOCIATES, PSC
Active
Other names
The Eye Care Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK M PRUSSIAN CEO (ADMINISTRATOR)
(502) 589-1500
Entity
Organization
Contact information
Practice address
1536 STORY AVE, LOUISVILLE, KY 40206-1738
(502) 589-1500
(502) 589-1556
Mailing address
1536 STORY AVE, LOUISVILLE, KY 40206-1738
(502) 589-1500
(502) 589-1556
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100221560
—
IN
05
—
65917502
—
KY
Enumeration date
01/19/2007
Last updated
01/18/2012
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