Healthcare Provider Details

I. General information

NPI: 1790745313
Provider Name (Legal Business Name): MATTAX NEU PRATER EYE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E PRIMROSE ST
SPRINGFIELD MO
65804-4278
US

IV. Provider business mailing address

1265 E PRIMROSE ST
SPRINGFIELD MO
65804-4278
US

V. Phone/Fax

Practice location:
  • Phone: 471-886-3937
  • Fax: 417-886-1285
Mailing address:
  • Phone: 471-886-3937
  • Fax: 417-886-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES B MATTAX JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 417-886-3937