Provider Demographics
NPI:1912974411
Name:VITREO-RETINAL CONSULTANTS
Entity type:Organization
Organization Name:VITREO-RETINAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:POER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-582-1118
Mailing Address - Street 1:8902 N MERIDIAN STREET
Mailing Address - Street 2:#120
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-582-1118
Mailing Address - Fax:317-582-1116
Practice Address - Street 1:8902 N MERIDIAN STREET
Practice Address - Street 2:#120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-582-1118
Practice Address - Fax:317-582-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN267120Medicare ID - Type Unspecified