Healthcare Provider Details

I. General information

NPI: 1811493729
Provider Name (Legal Business Name): ANDREW R OSBORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 EAST BRADFORD PARKWAY STE 100
SPRINGFIELD MO
65804-6539
US

IV. Provider business mailing address

1531 EAST BRADFORD PARKWAY STE 100
SPRINGFIELD MO
65804-6539
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-3900
  • Fax: 417-823-2894
Mailing address:
  • Phone: 417-887-3900
  • Fax: 417-823-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number34644
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: