Illinois Retina Institute, SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036100858 Issued in 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

Last updated

Oct 30, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kamal Kishore, MDNPI 1215059977

Title

President

Phone

(815) 223-7400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kamal Kishore, M.D.

  • Ophthalmology Physician
  • Peru, IL
  • NPI 1215059977
  Medicare reassignment Care Compare group NPD Authorized official
• Cristen Renee Banks

  • Nurse Practitioner
  • Peoria, IL
  • NPI 1275201360

  Ophthalmology

  Medicare reassignment Care Compare group NPD
• Aneesh Neekhra, MD

  • Neurology Physician
  • West Burlington, IA
  • NPI 1134384548

  IL, Ophthalmology

  Medicare reassignment Care Compare group NPD
• Roger Todd Adler, MD

  • Ophthalmology Physician
  • Pekin, IL
  • NPI 1063465110
  Medicare reassignment NPD
• Gynger Lentz, APRN

  • Nurse Practitioner
  • Peru, IL
  • NPI 1639801343
  Medicare reassignment NPD
• Brendon J Johnson, O.D.

  • Optometrist
  • Pekin, IL
  • NPI 1194774174
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Howell, MS., BCBA
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• I.V. Health Services, Inc. (Women's Health Care Center)
• Illinios Valley Oral Surgeons, P.C.
• Illinois Valley Acculabs LLC (Illinois Valley AccuLabs)
• Illinois Valley Autism Center
• Illinois Valley Ear, Nose & Throat Associates, Inc.
• Illinois Valley Endodontics LLC (Lee M. Ceresa DDS)
• Illinois Valley Spine Institute LLC

• Ophthalmology Physician in Peru, IL
• Providers in Peru, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.