Organization
RETINA INSTITUTE OF INDIANA, P.C.
Active
Other names
Vitreoretinal Consultants of Fort Wayne, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GOHAR AZAM SALAM MD (OWNER)
(260) 483-9500
Entity
Organization
Contact information
Practice address
11188 DIEBOLD RD, FORT WAYNE, IN 46845-9662
(260) 483-9500
(260) 483-9511
Mailing address
11188 DIEBOLD RD., FORT WAYNE, IN 46845-1712
(260) 483-9500
(260) 483-9511
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
50004672A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364631
ANTHEM BLUE CROSS
IN
01
—
17842
PHP
IN
05
—
200522580A
—
IN
01
—
7800696
AETNA
IN
Enumeration date
02/08/2007
Last updated
03/17/2016
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