Provider Demographics
NPI:1922078419
Name:EYE SURGERY CONSULTANTS, LLP
Entity Type:Organization
Organization Name:EYE SURGERY CONSULTANTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-686-4800
Mailing Address - Street 1:2210 BARRON RD
Mailing Address - Street 2:SUITE114
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-1908
Mailing Address - Country:US
Mailing Address - Phone:573-686-4800
Mailing Address - Fax:573-686-8448
Practice Address - Street 1:2210 BARRON RD
Practice Address - Street 2:SUITE114
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1908
Practice Address - Country:US
Practice Address - Phone:573-686-4800
Practice Address - Fax:573-686-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509773602Medicaid
MO509773602Medicaid