Summit Retina Consultants, P.C.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

50005075A Issued in IN

Legal business name

SUMMIT RETINA CONSULTANTS, P.C.

Practice address

6435 W Jefferson Blvd # 203
Fort Wayne, IN 46804-6203

Phone

(260) 515-2778

NPI assigned

Jan 21, 2010

Organization subpart

No

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

Authorized official

Name

Velimir Petrovic, MD

Title

President

Phone

(260) 515-2778

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264032000000",
    "number": "1124359708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6435 W JEFFERSON BLVD # 203",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6435 W JEFFERSON BLVD # 203",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046203",
            "telephone_number": "260-515-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT RETINA CONSULTANTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-21",
        "last_updated": "2010-01-21",
        "status": "A",
        "authorized_official_last_name": "PETROVIC",
        "authorized_official_first_name": "VELIMIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-515-2778",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "50005075A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.