# ILLINOIS RETINA INSTITUTE, SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003875436
- **Authorized official:** KAMAL KISHORE MD (PRESIDENT)
- **Authorized official phone:** (815) 223-7400

## Contact information

- **Practice address:** 3602 MARQUETTE RD, PERU, IL 61354-1450
- **Practice address phone:** (815) 223-7400
- **Practice address fax:** (815) 223-7477
- **Mailing address:** PO BOX 36, PERU, IL 61354-0036
- **Mailing address phone:** (815) 223-7400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 036100858 | IL | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 10/30/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036100858 | — | IL |