Illinois Retina Institute, SC

Key facts

NPI

1003875436

Entity type

Organization (NPI type 2)

Primary specialty

Ophthalmology Physician 207W00000X

License

036100858 (IL)

Legal business name

ILLINOIS RETINA INSTITUTE, SC

Practice address

3602 Marquette Rd
Peru, IL 61354-1450

Phone

(815) 223-7400

Fax

(815) 223-7477

NPI assigned

Mar 23, 2006

Organization subpart

No

Authorized official

Name

Kamal Kishore, MD NPI 1215059977

Title

President

Phone

(815) 223-7400

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kamal Kishore, M.D. Ophthalmology Physician · Peru, IL · NPI 1215059977
  Medicare reassignment Care Compare group NPD Authorized official IL · OPHTHALMOLOGY
• Cristen Renee Banks Nurse Practitioner · Peoria, IL · NPI 1275201360
  Medicare reassignment Care Compare group NPD IL · OPHTHALMOLOGY
• Aneesh Neekhra, MD Neurology Physician · West Burlington, IA · NPI 1134384548
  Medicare reassignment Care Compare group NPD IL · OPHTHALMOLOGY
• Roger Todd Adler, MD Ophthalmology Physician · Pekin, IL · NPI 1063465110
  Medicare reassignment NPD IL · OPHTHALMOLOGY
• Gynger Lentz, APRN Nurse Practitioner · Peru, IL · NPI 1639801343
  Medicare reassignment NPD IL
• Brendon J Johnson, O.D. Optometrist · Pekin, IL · NPI 1194774174
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 30, 2015.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446163200000",
    "number": "1003875436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613540036",
            "telephone_number": "815-223-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3602 MARQUETTE RD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541450",
            "telephone_number": "815-223-7400",
            "fax_number": "815-223-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS RETINA INSTITUTE, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2015-10-30",
        "status": "A",
        "authorized_official_last_name": "KISHORE",
        "authorized_official_first_name": "KAMAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-223-7400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036100858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100858",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IL

• Leslie Howell, MS., BCBA
• HW Holdings
• Hy-Vee Inc
• I.V. Health Services, Inc.
• Illinios Valley Oral Surgeons, P.C.
• Illinois Valley Acculabs LLC
• Illinois Valley Autism Center
• Illinois Valley Ear, Nose & Throat Associates, Inc.
• Illinois Valley Endodontics LLC
• Illinois Valley Spine Institute LLC

All providers in Peru, IL · Ophthalmology Physician in Illinois