Provider Demographics
NPI:1326328931
Name:URBAN EYE CARE
Entity Type:Organization
Organization Name:URBAN EYE CARE
Other - Org Name:VISION CLINIC DOWNTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCULLAWL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-862-3937
Mailing Address - Street 1:213 W OLIVE ST
Mailing Address - Street 2:101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-1301
Mailing Address - Country:US
Mailing Address - Phone:417-862-3937
Mailing Address - Fax:417-862-3936
Practice Address - Street 1:213 W OLIVE ST
Practice Address - Street 2:101
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1301
Practice Address - Country:US
Practice Address - Phone:417-862-3937
Practice Address - Fax:417-862-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006036228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty