Healthcare Provider Details

I. General information

NPI: 1316488414
Provider Name (Legal Business Name): RETINA HEALTH INSTITUTE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 HUNTINGTON DR N
ALGONQUIN IL
60102-4420
US

IV. Provider business mailing address

2320 HUNTINGTON DR N
ALGONQUIN IL
60102-4420
US

V. Phone/Fax

Practice location:
  • Phone: 847-488-1030
  • Fax: 847-488-0677
Mailing address:
  • Phone: 847-488-1030
  • Fax: 847-488-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036128045
License Number StateIL

VIII. Authorized Official

Name: DR. RASHMI KAPUR
Title or Position: MD & PRESIDENT
Credential: M.D.
Phone: 847-448-1030