MEDICARE: ERIN MAYFIELD OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2021021171	MO

General Provider Information

NPI Number	:	1104407261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MAYFIELD OD

Provider Business Mailing Address
First Line	:	808 GULF ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1239
Country	:	US
Telephone Number	:	417-682-3301
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 GULF ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1239
Country	:	US
Telephone Number	:	417-682-3301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	07/12/2021

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Directions to “ ERIN MAYFIELD OD” Practice Location

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