=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043270309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATED VITREORETINAL & UVEITIS CONSULTANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12794 HAMILTON CROSSING BLVD
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-571-1501
-----------------------------------------------------
Fax | 317-571-4806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12794 HAMILTON CROSSING BLVD
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-571-1501
-----------------------------------------------------
Fax | 317-571-4806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD OPTHALMOLOGIST
-----------------------------------------------------
Name | RAMANA S MOORTHY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 317-571-1501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------