Provider Demographics
NPI:1780880351
Name:JOPLIN EYE LASER CENTER INC
Entity type:Organization
Organization Name:JOPLIN EYE LASER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-621-0202
Mailing Address - Street 1:620 W 32ND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2528
Mailing Address - Country:US
Mailing Address - Phone:417-621-0202
Mailing Address - Fax:417-621-0206
Practice Address - Street 1:620 W 32ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2528
Practice Address - Country:US
Practice Address - Phone:417-621-0202
Practice Address - Fax:417-621-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014381207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000015374Medicare Oscar/Certification
E10976Medicare UPIN