Summit Retina Consultants, P.C.
Ophthalmology in Fort Wayne, IN. Organization (NPI-2).
NPI number1124359708
StatusActive
Last updated in NPPESJan 21, 2010
Details
- NPI
- 1124359708
- Entity type
- Organization (NPI-2)
- Legal business name
- Summit Retina Consultants, P.C.
- Organization subpart
- No
- Enumeration date
- Jan 21, 2010
- Last updated
- Jan 21, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207W00000X | Ophthalmology | 50005075A | IN | Yes |
Practice location
6435 W Jefferson Blvd # 203Fort Wayne, IN 46804-6203
Phone 260-515-2778
Mailing address
6435 W Jefferson Blvd # 203Fort Wayne, IN 46804-6203
Authorized official
Velimir Petrovic
President
2605152778
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