Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ridley Creek Retina LLC

Organization Internal Medicine Physician · NPI 1417564592

Ridley Creek Retina LLC is an Internal Medicine Physician in Media, Pennsylvania. Works from 2 locations. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

200 E State St Ste 303
Media, PA 19063-3434
Phone: (610) 892-1708
Fax: (610) 892-8766
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6532 Bayshore Blvd, Tampa, FL 33611-5505 — (610) 892-1708

Specialties & licences

Ophthalmology Physician (primary) Taxonomy 207W00000X
Internal Medicine Physician Taxonomy 207R00000X
Retina Specialist (Ophthalmology) Physician Taxonomy 207WX0107X
Ophthalmic Plastic and Reconstructive Surgery Physician Taxonomy 207WX0200X

Record details

NPI number1417564592
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jason Lange — President · (610) 892-1708
NPI enumeratedSeptember 23, 2020
Last updated in NPPESDecember 23, 2025
Certification dateDecember 23, 2025
Mailing address200 E State St Ste 303, Media, PA 19063-3434

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