Provider Demographics
NPI:1285767889
Name:MISSOURI EYE INSTITUTE OF JOPLIN LLC
Entity type:Organization
Organization Name:MISSOURI EYE INSTITUTE OF JOPLIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-887-3900
Mailing Address - Street 1:1531 EAST BRADFORD PARKWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6539
Mailing Address - Country:US
Mailing Address - Phone:417-887-3900
Mailing Address - Fax:417-823-2894
Practice Address - Street 1:4500 EAST 32ND STREET
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1512
Practice Address - Country:US
Practice Address - Phone:417-626-8082
Practice Address - Fax:417-626-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285767889OtherNPI
MO000015239OtherMEDICARE GROUP
MODF7539OtherRAILROAD MEDICARE GROUP