Healthcare Provider Details

I. General information

NPI: 1124910856
Provider Name (Legal Business Name): RETINA VISION CONSULTANTS 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 N BEDFORD DR FL 3
BEVERLY HILLS CA
90210-5124
US

IV. Provider business mailing address

360 N BEDFORD DR FL 3
BEVERLY HILLS CA
90210-5124
US

V. Phone/Fax

Practice location:
  • Phone: 800-841-5200
  • Fax:
Mailing address:
  • Phone: 800-841-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PRADEEP S. PRASAD
Title or Position: PARTNER
Credential: MD
Phone: 800-841-5200