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General NPI Number Information
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NPI Number | 1417052291
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Entity Type | Organization
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Legal Business Name | MATTAX NEU PRATER EYE CENTER, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 168 S PAYNE STEWART DR SUITE 200
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City | BRANSON
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State | MO
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Zip | 65616-2792
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Country | US
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Telephone | 417-886-3937
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Fax | 417-886-1285
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Provider Business Mailing Address
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Address Line | 1265 E PRIMROSE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4278
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Country | US
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Telephone | 417-886-3937
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Fax | 417-886-1285
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES B. MATTAX
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Credential | MD
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Telephone | 417-886-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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