Healthcare Provider Details

I. General information

NPI: 1861485138
Provider Name (Legal Business Name): DISCOVER EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S CLIFF AVE STE 101
INDEPENDENCE MO
64055-7015
US

IV. Provider business mailing address

4801 S CLIFF AVE STE 100
INDEPENDENCE MO
64055-7015
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4400
  • Fax: 816-478-8240
Mailing address:
  • Phone: 816-478-4400
  • Fax: 816-478-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1153
License Number StateMO

VIII. Authorized Official

Name: MELINDA HAMILTON
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 816-350-4536