Retina Group of Texas, PLLC

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

RETINA GROUP OF TEXAS, PLLC

Practice address

13625 Ronald Reagan Blvd BLDG 9
Ste 100
Cedar Park, TX 78613-2073

Phone

(512) 856-5645

Fax

(833) 703-0656

NPI assigned

Feb 14, 2019

Organization subpart

No

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

Authorized official

Name

Chaitanya Indukuri, MDNPI 1912224031

Title

Managing Partner

Phone

(512) 856-5645

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Chaitanya Indukuri, MD

  • Ophthalmology Physician
  • Cedar Park, TX
  • NPI 1912224031

  Retina Specialist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1952867996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13625 RONALD REAGAN BLVD BLDG 9",
            "address_2": "STE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132073",
            "telephone_number": "512-856-5645",
            "fax_number": "512-729-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13625 RONALD REAGAN BLVD BLDG 9",
            "address_2": "STE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132073",
            "telephone_number": "512-856-5645",
            "fax_number": "833-703-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA GROUP OF TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-14",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "INDUKURI",
        "authorized_official_first_name": "CHAITANYA",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "512-856-5645",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vincent Anthony Restivo, M.D.
• Monica Maria Reveley, RBT
• Stacey Lavoro Rexrode, PH.D.
• Jennifer Guevara Reyes, M.ED, LPC-S, RPT-S
• Gabriela Reyna-Ortega, LPC ASSOCIATE
• Jennifer Cary Reynolds, M.ED, BCBA

• Retina Specialist (Ophthalmology) Physician in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Retina Specialist (Ophthalmology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; 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.