| Ridley Creek Retina Llc | |
|
200 E State St Ste 105 Media PA 19063-3434 | |
| (610) 892-1708 | |
| (610) 892-8766 |
| Full Name | Ridley Creek Retina Llc |
|---|---|
| Speciality | Ophthalmology |
| Location | 200 E State St Ste 105, Media, Pennsylvania |
| Authorized Official Name and Position | Jason Lange (PRESIDENT) |
| Authorized Official Contact | 6108921708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridley Creek Retina Llc 200 E State St Ste 105 Media PA 19063-3434 Ph: (610) 892-1708 | Ridley Creek Retina Llc 200 E State St Ste 105 Media PA 19063-3434 Ph: (610) 892-1708 |
| NPI Number | 1417564592 |
|---|---|
| Provider Enumeration Date | 09/23/2020 |
| Last Update Date | 09/23/2020 |
| Medicare PECOS PAC ID | 1951711282 |
|---|---|
| Medicare Enrollment ID | O20201028000042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417564592 | NPI | - | NPPES |
| Provider Name | Andrea M Saxon |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1538240700 PECOS PAC ID: 6709788425 Enrollment ID: I20040123000158 |
| Provider Name | Weiye Li |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1659340420 PECOS PAC ID: 4082673363 Enrollment ID: I20071005000176 |
| Provider Name | Maximilian Padilla |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1235557166 PECOS PAC ID: 2668691718 Enrollment ID: I20180711003269 |
| Provider Name | Jason Robert Lange |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1174937775 PECOS PAC ID: 6406266733 Enrollment ID: I20201028000068 |
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