MEDICARE: MISSOURI EYE INSTITUTE OF JOPLIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000015239	OTHER	MO	MEDICARE GROUP
3	DF7539	OTHER	MO	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285767889	OTHER	MO	NPI

General Provider Information

NPI Number	:	1285767889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI EYE INSTITUTE OF JOPLIN LLC

Provider Business Mailing Address
First Line	:	1531 EAST BRADFORD PARKWAY STE 100
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-6539
Country	:	US
Telephone Number	:	417-887-3900
Fax Number	:	417-823-2894

Provider Business Practice Location Address
First Line	:	4500 EAST 32ND STREET
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64804-1512
Country	:	US
Telephone Number	:	417-626-8082
Fax Number	:	417-626-4393

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL R OSBORN JR.
Credential	:	MD
Telephone Number	:	417-887-3900

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	03/20/2024

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Directions to “MISSOURI EYE INSTITUTE OF JOPLIN LLC ” Practice Location

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