Healthcare Provider Details

I. General information

NPI: 1104407261
Provider Name (Legal Business Name): ERIN MAYFIELD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/12/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 GULF ST
LAMAR MO
64759-1239
US

IV. Provider business mailing address

808 GULF ST
LAMAR MO
64759-1239
US

V. Phone/Fax

Practice location:
  • Phone: 417-682-3301
  • Fax:
Mailing address:
  • Phone: 417-682-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2021021171
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: