RETINA INSTITUTE OF INDIANA, P.C. (NPI# 1457492167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457492167 |
| Entity Type | Organization |
| Organization Name | RETINA INSTITUTE OF INDIANA, P.C. |
| Other Organization Name | VITREORETINAL CONSULTANTS OF FORT WAYNE, P.C. |
| Practice Address |
11188 Diebold Rd Fort Wayne IN 46845-9662 |
| Mailing Address |
11188 Diebold Rd. Fort Wayne IN 46845-1712 |
| Practice Telephone | 2604839500 |
| Practice Fax Number | 2604839511 |
| Mailing Telephone | 2604839500 |
| Mailing Fax Number | 2604839511 |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2016-03-17 |
| Authorized Official Name | DR. GOHAR AZAM SALAM (OWNER) |
| Authorized Official Telephone | 2604839500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 50004672A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | PHP | 17842 | 01 |
| IN | 200522580A | 05 | |
| IN | ANTHEM BLUE CROSS | 000000364631 | 01 |
| IN | AETNA | 7800696 | 01 |
| Other Name | Type Code |
|---|---|
| Vitreoretinal Consultants of Fort Wayne, P.C. | Former Legal Business Name - Organization |
| Street Address |
11188 DIEBOLD RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845-9662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285635334 | Gohar A Salam | Ophthalmology | 11188 Diebold Rd, Fort Wayne, IN 46845-9662 | 2005-08-10 |
| 1841510294 | Adeel N Khan | Ophthalmology | 11188 Diebold Rd, Fort Wayne, IN 46845-9662 | 2010-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| Find all providers in zip 46845 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986162 | Northeast Ophthalmology P C | Ophthalmology | 7750 W Jefferson Blvd Ste B, Fort Wayne, IN 46804-4174 | 2019-08-07 |
| 1730442559 | Retina Institute of Indiana Surgery Center, LLC | Ophthalmology | 11192 Diebold Rd, Fort Wayne, IN 46845-9662 | 2012-06-18 |
| 1124359708 | Summit Retina Consultants, P.C. | Ophthalmology | 6435 W Jefferson Blvd # 203, Fort Wayne, IN 46804-6203 | 2010-01-21 |
| 1306806302 | Daniel Edward Krach | Ophthalmology | 2510 E Dupont Rd Ste 128, Fort Wayne, IN 46825-1603 | 2006-03-24 |
| 1982690566 | Randal K Hughes | Ophthalmology | 7747 W Jefferson Blvd, Suite A, Fort Wayne, IN 46804 | 2005-09-20 |
| 1568456549 | Earl Albert Braunlin | Ophthalmology | 717 W Jefferson Blvd, Fort Wayne, IN 46802-4002 | 2005-09-07 |
| 1285635334 | Gohar A Salam | Ophthalmology | 11188 Diebold Rd, Fort Wayne, IN 46845-9662 | 2005-08-10 |
| 1154329100 | Barbara Schroeder | Ophthalmology | 3301 Lake Ave, Fort Wayne, IN 46805-5529 | 2005-07-13 |
| 1922433614 | Allied Physicians Inc | Ophthalmology | 2510 E Dupont Rd Ste 128, Fort Wayne, IN 46825-1603 | 2013-09-12 |
| 1447690896 | Anne Schroeder Krafsig | Ophthalmology | 3301 Lake Ave, Fort Wayne, IN 46805-5529 | 2013-06-30 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.