Organization
SUDARSAN CHAVALA
Active
Other names
maryville eye clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUDARSAN CHAVALA M.D. (OPHTHALMOLOGIST)
(660) 562-2566
Entity
Organization
Contact information
Practice address
2024 S MAIN ST, MARYVILLE, MO 64468-2655
(660) 562-2566
(660) 562-2432
Mailing address
2024 S MAIN ST, MARYVILLE, MO 64468-2655
(660) 562-2566
(660) 562-2432
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R8855
MO
332H00000X
Eyewear Supplier
R8855
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180023483
MEDICARE RAILROAD
MO
05
—
201965209
—
MO
01
—
22841019
BCBS OF KC
MO
05
—
321965204
—
MO
Enumeration date
04/07/2007
Last updated
06/30/2008
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