RETINA VITREOUS CENTER PLLC NPI 1811284946

NPI Information

NPI: 1811284946
Provider Name: RETINA VITREOUS CENTER, PLLC
Classification: Ophthalmology - 207WX0107X
Entity Type: Organization

Specialization: Retina Specialist

CLIA Number: 37D2106972

Address:
1851 S KELLY AVE STE A
EDMOND, OK
ZIP 73013
Phone: (405) 607-6699
Get Directions

RETINA VITREOUS CENTER, PLLC is a retina specialist ophthalmology in Edmond, OK. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. RETINA VITREOUS CENTER, PLLC NPI is 1811284946. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1851 S KELLY AVE STE A
EDMOND, OK
ZIP 73013-602
Phone: (405) 607-6699
Fax: (405) 607-6685

The provider's authorized official is Sandeep N. Shah .
The authorized official title is Founding Manager and has the following contact phone number (405) 607-6699.

The CLIA number assigned to this NPI record is 37D2106972 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/10/2011 and was last updated on 2/19/2024.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	152W00000X	Optometrist				No
2	207WX0107X	Ophthalmology	Retina Specialist			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200198330A	MEDICAID	OKLAHOMA

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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