Provider Demographics
NPI:1790745313
Name:MATTAX NEU PRATER EYE CENTER, INC.
Entity Type:Organization
Organization Name:MATTAX NEU PRATER EYE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATTAX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-886-3937
Mailing Address - Street 1:1265 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4278
Mailing Address - Country:US
Mailing Address - Phone:471-886-3937
Mailing Address - Fax:417-886-1285
Practice Address - Street 1:1265 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4278
Practice Address - Country:US
Practice Address - Phone:471-886-3937
Practice Address - Fax:417-886-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCI7181OtherRAILROAD MEDICARE PART B
MO506240704Medicaid
MO506240704Medicaid