Retina & Vitreous L L C

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

RETINA & VITREOUS L L C

Practice address

53822 Generations Drive
South Bend, IN 46635-1543

Phone

(574) 233-3711

Fax

(574) 288-1702

NPI assigned

Dec 19, 2007

Last updated

Jul 12, 2017By 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

Robert T Lee, MDNPI 1962401869

Title

Partner

Phone

(574) 233-3711

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

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.

• Robert Lee, MD

  • Ophthalmology Physician
  • South Bend, IN
  • NPI 1962401869
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1093999609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53822 GENERATIONS DRIVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351543",
            "telephone_number": "574-233-3711",
            "fax_number": "574-288-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53822 GENERATIONS DRIVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351543",
            "telephone_number": "574-233-3711",
            "fax_number": "574-288-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA & VITREOUS L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "574-233-3711",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200883090",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000549277",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jan Reineke, M.D.
• McKinzie Reith, BCBA, LBA
• Kiersten Remenih, BSW
• John T Renzi, MD
• Resource Nurse Staffing LLC (RNS Medical Solutions)
• Revive Counseling and Wellness
• Tyler Allen Rex
• Cristina Reyes, MSW
• Reyna Reyes, BSN, RN
• Catherine Reynoso

• Ophthalmology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; 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.