IndividualActive
Sreenivasa Basavanthappa, MD
NPI 1497953871 · Retina Specialist (Ophthalmology) Physician · Bloomington, IL
Provider details
- NPI number
- 1497953871
- Entity type
- Individual
- Primary specialty
- Retina Specialist (Ophthalmology) PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 03-6163408 (IL)
Practice location
2501 E College Ave Ste B
Bloomington, IL 61704-2484
Phone: (309) 557-8666
Fax: (309) 827-8027
Mailing address
1008 N Main St
Bloomington, IL 61701-1784
Registry dates
- Enumerated
- 2007-07-06
- Last updated
- 2023-12-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.