=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053454728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEDALIA EYE ASSOCIATES, P. C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 12/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 COMERCIAL ST SUITE 202
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65355-1599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-438-6699
-----------------------------------------------------
Fax | 660-438-4450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 W 10TH ST
-----------------------------------------------------
City | SEDALIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65301-2198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-827-1120
-----------------------------------------------------
Fax | 660-827-2756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK TAYLOR COX
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 660-438-6699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------