Organization
SPRINGFIELD EYE & PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDON DELPORT D.O. (OWNER)
(417) 496-3664
Entity
Organization
Contact information
Practice address
2828 N NATIONAL AVE, SUITE E, SPRINGFIELD, MO 65803-4306
(417) 837-4238
(417) 875-4728
Mailing address
PO BOX 70, OZARK, MO 65721-0070
(417) 837-4238
(417) 875-4728
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2004008249
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194721100
INDIVIDUAL NPI
—
05
—
209165604
—
MO
01
—
DO5151
RR MEDICARE PTAN
—
Enumeration date
05/08/2007
Last updated
03/13/2013
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