Healthcare Provider Details

I. General information

NPI: 1952315939
Provider Name (Legal Business Name): EYE PHYSICIANS OF SPRINGFIELD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 OLYMPIC ST
SPRINGFIELD OH
45503-2737
US

IV. Provider business mailing address

2254 OLYMPIC ST
SPRINGFIELD OH
45503-2737
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-8287
  • Fax: 937-399-1670
Mailing address:
  • Phone: 937-399-8287
  • Fax: 937-399-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: JERRY K SHELL
Title or Position: PRESIDENT
Credential: MD
Phone: 937-399-8287