Healthcare Provider Details

I. General information

NPI: 1043270309
Provider Name (Legal Business Name): ASSOCIATED VITREORETINAL & UVEITIS CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12794 HAMILTON CROSSING BLVD
CARMEL IN
46032-5422
US

IV. Provider business mailing address

12794 HAMILTON CROSSING BLVD
CARMEL IN
46032-5422
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-1501
  • Fax: 317-571-4806
Mailing address:
  • Phone: 317-571-1501
  • Fax: 317-571-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAMANA S MOORTHY
Title or Position: MD OPTHALMOLOGIST
Credential: MD
Phone: 317-571-1501