Organization
VITREO RETINAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRINCE D SAMUEL MD (OWNER)
(812) 476-6500
Entity
Organization
Contact information
Practice address
4221 WASHINGTON AVE, EVANSVILLE, IN 47714
(812) 476-6500
(812) 476-6507
Mailing address
4221 WASHINGTON AVE, EVANSVILLE, IN 47714-0675
(812) 476-6500
(812) 476-6507
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200885330A
—
IN
Enumeration date
02/15/2007
Last updated
08/08/2018
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