# RETINA VITREOUS CENTER, PLLC

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

## Provider details

- **NPI number:** 1811284946
- **Authorized official:** DR. SANDEEP N. SHAH M.D. (FOUNDING MANAGER)
- **Authorized official phone:** (405) 607-6699

## Contact information

- **Practice address:** 1851 S KELLY AVE STE A, EDMOND, OK 73013-3929
- **Practice address phone:** (405) 607-6699
- **Practice address fax:** (405) 607-6685
- **Mailing address:** PO BOX 410108, KANSAS CITY, MO 64141-0108
- **Mailing address phone:** (405) 607-6699
- **Mailing address fax:** (405) 607-6685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/10/2011
- **Last updated:** 09/30/2026