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General NPI Number Information
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NPI Number | 1821101189
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Entity Type | Organization
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Legal Business Name | COLLINS EYE CLINIC, L.L.C.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 1342 E PRIMROSE ST SUITE B
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4279
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Country | US
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Telephone | 417-869-3200
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Fax | 417-869-3212
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Provider Business Mailing Address
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Address Line | 1342 E PRIMROSE ST SUITE B
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4279
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Country | US
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Telephone | 417-869-3200
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Fax | 417-869-3212
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DEANN R EDELSTEIN
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Credential |
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Telephone | 417-869-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 114662
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License Number State | MO
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