Retina Vitreous Center, Pllc | |
1851 S Kelly Ave Ste A, Edmond, OK 73013-3602 | |
(405) 607-6699 | |
(405) 607-6685 |
Full Name | Retina Vitreous Center, Pllc |
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Type | Facility |
Speciality | Ophthalmology - Retina Specialist |
Location | 1851 S Kelly Ave Ste A, Edmond, Oklahoma |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1811284946 | NPI | - | NPPES |
200198330A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | (* (Not Available)) | Secondary |
207WX0107X | Ophthalmology - Retina Specialist | (* (Not Available)) | Primary |
Provider Name | Sandeep N Shah |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1154362770 PECOS PAC ID: 2567466527 Enrollment ID: I20080616000645 |
Provider Name | Brian S Phelps |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1689866576 PECOS PAC ID: 1850561655 Enrollment ID: I20130824000062 |
Provider Name | Ryan M Ridges |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1780634782 PECOS PAC ID: 3779654595 Enrollment ID: I20151002000078 |
Provider Name | Michael P Hood |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1386932333 PECOS PAC ID: 7214173756 Enrollment ID: I20190131000690 |
Provider Name | Sahab Astani |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1174142418 PECOS PAC ID: 0345645297 Enrollment ID: I20210816003596 |
Provider Name | David Josip Grasic |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1982256558 PECOS PAC ID: 9436548781 Enrollment ID: I20240122000528 |
Mailing Address | Practice Location Address |
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Retina Vitreous Center, Pllc P.o. Box 2492, Edmond, OK 73083-2492 Ph: (405) 292-5500 | Retina Vitreous Center, Pllc 1851 S Kelly Ave Ste A, Edmond, OK 73013-3602 Ph: (405) 607-6699 |