Provider Demographics
NPI:1518531649
Name:VIRATA RETINA CENTER LLC
Entity Type:Organization
Organization Name:VIRATA RETINA CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIRATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-573-8462
Mailing Address - Street 1:150 PROFESSIONAL CT STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5153
Mailing Address - Country:US
Mailing Address - Phone:765-573-8462
Mailing Address - Fax:765-767-4818
Practice Address - Street 1:150 PROFESSIONAL CT STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5153
Practice Address - Country:US
Practice Address - Phone:765-573-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty