Provider Demographics
NPI:1851840599
Name:HIGHLAND RETINA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HIGHLAND RETINA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:IZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-281-2608
Mailing Address - Street 1:4621 E MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9303
Mailing Address - Country:US
Mailing Address - Phone:812-281-2608
Mailing Address - Fax:812-281-2610
Practice Address - Street 1:4621 E MARGARET DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9303
Practice Address - Country:US
Practice Address - Phone:812-281-2608
Practice Address - Fax:812-281-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077271A207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty