Retinal Vitreal Consultants LTD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

RETINAL VITREAL CONSULTANTS LTD

Practice address

2600 S Michigan Ave
Ste 212
Chicago, IL 60616-2859

Phone

(312) 567-2795

Fax

(800) 707-4890

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Shaun T Ittiara, MDNPI 1992995542

Title

Authorized Official

Phone

(312) 567-2795

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IAJCBD

Practitioners 6

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

• Shaun T Ittiara, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Chicago, IL
  • NPI 1992995542
  Medicare reassignment Care Compare group NPD Authorized official
• Paulpoj Chiranand, MD

  • Retina Specialist (Ophthalmology) Physician
  • Chicago, IL
  • NPI 1639377260
  Medicare reassignment Care Compare group NPD
• James C Liang, M.D.

  • Ophthalmology Physician
  • Oak Lawn, IL
  • NPI 1578541983
  Medicare reassignment Care Compare group NPD
• Obadah Moushmoush, MD

  • Ophthalmology Physician
  • Chicago, IL
  • NPI 1861020281
  Medicare reassignment NPD
• Calvin Alexander Grant, M.D.

  • Ophthalmology Physician
  • Palos Heights, IL
  • NPI 1679551014
  NPD (past)
• Lance V Scott, M.D.

  • Ophthalmology Physician
  • Oklahoma City, OK
  • NPI 1417958059
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1164569380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 166516",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606166516",
            "telephone_number": "312-567-2795",
            "fax_number": "800-707-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S MICHIGAN AVE",
            "address_2": "STE 212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162859",
            "telephone_number": "312-567-2795",
            "fax_number": "800-707-4890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3241 S Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606164201",
            "country_code": "US",
            "telephone_number": "312-949-7221",
            "fax_number": "312-949-7667",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4429 W 95th St",
            "address_purpose": "LOCATION",
            "city": "Oak Lawn",
            "state": "IL",
            "postal_code": "604532625",
            "country_code": "US",
            "telephone_number": "708-422-2665",
            "fax_number": "708-422-2997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RETINAL VITREAL CONSULTANTS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "ITTIARA",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "312-567-2795",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Retina Services of Illinois, LLC
• Retrofit, Inc.
• Carolyn D Retterer, MS,RPH
• Anna Rettig
• Mateya Rettig, PT, DPT
• Gloria Toy Rettke, MHS CCC-SLP/L

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.