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General NPI Number Information
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NPI Number | 1558766006
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Entity Type | Organization
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Legal Business Name | OZARK RETINA & MACULA
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 1230 E KINGSLEY ST STE A
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7231
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Country | US
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Telephone | 417-830-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 E KINGSLEY ST STE A
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7231
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Country | US
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Telephone | 417-830-0889
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Fax |
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Authorized Official
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Title or Position | RETINA SPECIALIST
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Name | DR. ROBERT EDWIN BENEDETT
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Credential | M.D.
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Telephone | 417-830-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MDR3K52
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License Number State | MO
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