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Organization
RETINA VITREOUS CENTER, PLLC
Active
Organization
RETINA VITREOUS CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDEEP N. SHAH M.D. (FOUNDING MANAGER)
(405) 607-6699
Entity
Organization
Contact information
Practice address
1851 S KELLY AVE STE A, EDMOND, OK 73013-3929
(405) 607-6699
(405) 607-6685
Mailing address
PO BOX 410108, KANSAS CITY, MO 64141-0108
(405) 607-6699
(405) 607-6685
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
NULL
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Enumeration date
07/10/2011
Last updated
09/30/2026
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