Louisville Retina PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

LOUISVILLE RETINA PLLC

Practice address

1169 Eastern Pkwy Ste 3323
Louisville, KY 40217-1415

Phone

(718) 300-1540

NPI assigned

Oct 26, 2021

Organization subpart

No

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

Authorized official

Name

Anupa Mandava, MDNPI 1710257316

Title

MD

Phone

(718) 300-1540

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

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.

• Anupa Mandava, M.D.

  • Ophthalmology Physician
  • Louisville, KY
  • NPI 1710257316
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1215691308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 EASTERN PKWY STE 3323",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171415",
            "telephone_number": "502-873-0900",
            "fax_number": "502-873-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 EASTERN PKWY STE 3323",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171415",
            "telephone_number": "718-300-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISVILLE RETINA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-26",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "MANDAVA",
        "authorized_official_first_name": "ANUPA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "718-300-1540",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100779210",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louisville Pulmonary Associates, PSC
• Louisville Pulmonary Care PLLC
• Louisville Recovery Center
• Louisville Recovery Center
• Louisville Reproductive Center LLC
• Louisville Ride
• Louisville Sleep Disorders Center LLC
• Louisville Sleep Lab LLC
• Louisville Smiles Youth Dentistry, PSC
• Louisville Speech Spot, LLC

• Ophthalmology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Ophthalmology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.