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ILLINOIS RETINA INSTITUTE SC NPI 1003875436


NPI Information

NPI: 1003875436
Provider Name: ILLINOIS RETINA INSTITUTE, SC
Classification: Ophthalmology - 207W00000X
Entity Type: Organization

CLIA Number: 14D2211884

Address:
3602 MARQUETTE RD
PERU, IL
ZIP 61354
Phone: (815) 223-7400
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ILLINOIS RETINA INSTITUTE, SC is an ophthalmology in Peru, IL. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. ILLINOIS RETINA INSTITUTE, SC NPI is 1003875436. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3602 MARQUETTE RD
PERU, IL
ZIP 61354-450
Phone: (815) 223-7400
Fax: (815) 223-7477

The provider's authorized official is Kamal Kishore .
The authorized official title is President and has the following contact phone number (815) 223-7400.

The CLIA number assigned to this NPI record is 14D2211884 - other - homeless sheler with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/23/2006 and was last updated on 10/30/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207W00000XOphthalmology036100858ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1G54298MEDICARE UPIN
2204115MEDICARE PINILLINOIS
3036100858MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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