Organization
MATTAX NEU PRATER EYE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES B MATTAX JR. MD (PRESIDENT)
(417) 886-3937
Entity
Organization
Contact information
Practice address
1265 E PRIMROSE ST, SPRINGFIELD, MO 65804-4278
(471) 886-3937
(417) 886-1285
Mailing address
1265 E PRIMROSE ST, SPRINGFIELD, MO 65804-4278
(471) 886-3937
(417) 886-1285
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506240704
—
MO
01
—
CI7181
RAILROAD MEDICARE PART B
MO
Enumeration date
03/27/2006
Last updated
05/05/2016
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