NPIMap

Organization Active NPI

Alliance Retina

  • Retina Specialist (Ophthalmology) Physician
  • Maumee, OH
National Provider Identifier
1669811774
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
ALLIANCE RETINA
Practice address
5757 Monclova Rd Ste 11
Maumee, OH 43537-1863
Phone
(419) 873-6800
Fax
(419) 873-6804
NPI assigned
Jun 21, 2013
Last updated
Mar 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Gregory Rosenthal, MDNPI 1710959549
Title
President
Phone
(419) 873-6800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

5757 Monclova Rd Ste 11
Maumee, OH 43537-1863

Mailing address

5757 Monclova Rd Ste 11
Maumee, OH 43537-1863
Phone (419) 356-4224

Other practice location 1

28370 Kensington Lane
Suite A
Perrysburg, OH 43551
Phone (419) 874-3125

Other identifiers 1

IdentifierTypeStateIssuer
0749300MedicaidOH

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: dmangla@allianceretinallc.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1669811774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD STE 11",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-356-4224",
            "fax_number": "419-873-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD STE 11",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-873-6800",
            "fax_number": "419-873-6804"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28370 Kensington Lane",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Perrysburg",
            "state": "OH",
            "postal_code": "43551",
            "country_code": "US",
            "telephone_number": "419-874-3125",
            "fax_number": "419-874-8606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALLIANCE RETINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "ROSENTHAL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-873-6800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0749300",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.