VIRDI EYE CLINIC LASER VISION CENTER
Complete NPI Record 1811950892
Ophthalmology in Rock Island, IL
Active since April 10, 2006CLIA 14D2062270 · Waiver
Complete NPI Dataset
This page contains the complete raw NPPES record for Virdi Eye Clinic Laser Vision Center (NPI 1811950892), an ophthalmology organization in Rock Island, IL. All 31 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1811950892 Field 1/31
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/31
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/31
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: PREM S VIRDI MD PC Field 4/31
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: VIRDI EYE CLINIC LASER VISION CENTER Field 5/31
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/31
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 4600 30TH ST Field 7/31
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: ROCK ISLAND Field 8/31
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IL Field 9/31
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 612017038 Field 10/31
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/31
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 3097885524 Field 12/31
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 3097889550 Field 13/31
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 4600 30TH ST Field 14/31
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: ROCK ISLAND Field 15/31
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IL Field 16/31
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 612017038 Field 17/31
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/31
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3097885524 Field 19/31
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 3097889550 Field 20/31
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: VIRDI Field 23/31
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: PREM Field 24/31
- The first name of the authorized official.
- Authorized Official Middle Name: S Field 25/31
- The middle name of the authorized official.
- Authorized Official Title or Position: PHYSICIAN Field 26/31
- The title or position of the authorized official.
- Authorized Official Telephone Number: 3097885524 Field 27/31
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207W00000X Field 28/31
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 29/31
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 30/31
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP Field 31/31
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Provider Identifiers 2
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
0314410001 Medicare NSC
Identifier 1/2State: IL
Medicare NSC: Used in the "Other Provider Identifier" field when listing non-NPI legacy provider numbers associated with a health care practitioner or organization in NPPES.
Medicare NSC: Used in the "Other Provider Identifier" field when listing non-NPI legacy provider numbers associated with a health care practitioner or organization in NPPES.
211867 Medicare ID-Type Unspecified
Identifier 2/2Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
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