Organization
RETINAL VITREAL CONSULTANTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN T ITTIARA MD (AUTHORIZED OFFICIAL)
(312) 567-2795
Entity
Organization
Contact information
Practice address
2600 S MICHIGAN AVE, STE 212, CHICAGO, IL 60616-2859
(312) 567-2795
(800) 707-4890
Mailing address
PO BOX 166516, CHICAGO, IL 60616-6516
(312) 567-2795
(800) 707-4890
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
Other
Enumeration date
01/30/2007
Last updated
07/05/2023
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