Provider Demographics
NPI:1043270309
Name:ASSOCIATED VITREORETINAL AND UVEITIS CONSULTANTS LLC
Entity Type:Organization
Organization Name:ASSOCIATED VITREORETINAL AND UVEITIS CONSULTANTS LLC
Other - Org Name:AVRUC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OPTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-571-1501
Mailing Address - Street 1:10585 N MERIDIAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1066
Mailing Address - Country:US
Mailing Address - Phone:317-571-1501
Mailing Address - Fax:317-571-4806
Practice Address - Street 1:10585 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1066
Practice Address - Country:US
Practice Address - Phone:317-571-1501
Practice Address - Fax:317-571-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037732A207W00000X
IN01060046A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201246530Medicaid
IN088990Medicare PIN
F41153Medicare UPIN
IN088990BMedicare PIN