Provider Demographics
NPI:1912911827
Name:RETINA INSTITUTE, P.C.
Entity Type:Organization
Organization Name:RETINA INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-573-4410
Mailing Address - Street 1:9002 N MERIDIAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5349
Mailing Address - Country:US
Mailing Address - Phone:317-573-4410
Mailing Address - Fax:317-573-4412
Practice Address - Street 1:9002 N MERIDIAN ST STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5349
Practice Address - Country:US
Practice Address - Phone:317-573-4410
Practice Address - Fax:317-573-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003889A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN895620Medicare PIN