Healthcare Provider Details

I. General information

NPI: 1326328931
Provider Name (Legal Business Name): URBAN EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W OLIVE ST 101
SPRINGFIELD MO
65806-1301
US

IV. Provider business mailing address

213 W OLIVE ST 101
SPRINGFIELD MO
65806-1301
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-3937
  • Fax: 417-862-3936
Mailing address:
  • Phone: 417-862-3937
  • Fax: 417-862-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2006036228
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW K SCULLAWL
Title or Position: OWNER
Credential: OD
Phone: 417-862-3937