Provider Demographics
NPI:1790299311
Name:SPRINGFIELD EYE SPECIALISTS LLC
Entity Type:Organization
Organization Name:SPRINGFIELD EYE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-820-9393
Mailing Address - Street 1:3041 S KIMBROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4856
Mailing Address - Country:US
Mailing Address - Phone:954-560-2662
Mailing Address - Fax:417-470-3938
Practice Address - Street 1:3041 S KIMBROUGH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4856
Practice Address - Country:US
Practice Address - Phone:417-470-3937
Practice Address - Fax:417-470-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02895152W00000X
MO2015011922332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear Supplier