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General NPI Number Information
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NPI Number | 1841333036
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Entity Type | Organization
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Legal Business Name | VITREO RETINAL CENTER PC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 4221 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714
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Country | US
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Telephone | 812-476-6500
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Fax | 812-476-6507
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Provider Business Mailing Address
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Address Line | 4221 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-0675
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Country | US
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Telephone | 812-476-6500
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Fax | 812-476-6507
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRINCE D SAMUEL
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Credential | MD
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Telephone | 812-476-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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