=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861485138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVER EYE SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 02/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 S CLIFF AVE STE 101
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-7015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-478-4400
-----------------------------------------------------
Fax | 816-478-8240
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4801 S CLIFF AVE STE 100
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-7015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-478-4400
-----------------------------------------------------
Fax | 816-478-8240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ASSISTANT
-----------------------------------------------------
Name | MELINDA HAMILTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-350-4536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 1153
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------