Retina Center of Maine, LLC PA

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

MD14047 Issued in ME

Legal business name

RETINA CENTER OF MAINE, LLC PA

Practice address

195 Fore River Pkwy Ste 480
Portland, ME 04102-2787

Phone

(207) 773-3937

Fax

(207) 773-0801

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mark Wilson Balles, MD

Title

MD / Practice Owner

Phone

(207) 773-3937

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dustin Lewis Pomerleau, MD

  • Ophthalmology Physician
  • Portland, ME
  • NPI 1922247923
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1801077128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 FORE RIVER PKWY STE 480",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022787",
            "telephone_number": "207-773-3937",
            "fax_number": "207-773-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 FORE RIVER PKWY STE 480",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022787",
            "telephone_number": "207-773-3937",
            "fax_number": "207-773-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA CENTER OF MAINE, LLC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "BALLES",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "MD / PRACTICE OWNER",
        "authorized_official_telephone_number": "207-773-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "ME",
            "license": "MD14047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garrett Ressler, DPT
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• Paul Joseph Revier, LCSW
• Christina Noel Reville
• Patricia J Rewak, NP
• Thalia Reyes, CRNA
• Leasly Anabelle Reyna

• Retina Specialist (Ophthalmology) Physician in Portland, ME
• Providers in Portland, ME by specialty
• Retina Specialist (Ophthalmology) Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.