| NPI | 1457492167 |
|---|---|
| Former Legal Business Name | VITREORETINAL CONSULTANTS OF FORT WAYNE, P.C. |
| Entity Type | Organization |
| Authorized Contact | GOHAR AZAM SALAM Owner 260-483-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IN 50004672A) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2016-03-17 |