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General NPI Number Information
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NPI Number | 1134914294
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Entity Type | Organization
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Legal Business Name | VITREORETINAL ALLIANCE PLLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 5418 E ARROWHEAD PKWY
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City | SIOUX FALLS
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State | SD
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Zip | 57110-0401
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Country | US
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Telephone | 605-705-3322
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Fax | 605-705-3322
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Provider Business Mailing Address
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Address Line | 5418 E ARROWHEAD PKWY
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City | SIOUX FALLS
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State | SD
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Zip | 57110-0401
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Country | US
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Telephone | 605-705-3322
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Fax | 605-705-3322
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Authorized Official
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Title or Position | PRESIDENT - OWNER
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Name | DR. JED HAMAD ASSAM
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Credential | MD
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Telephone | 605-705-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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