Provider Demographics
NPI:1932232345
Name:MISSOURI EYE INSTITUTE OF BRANSON LLC
Entity Type:Organization
Organization Name:MISSOURI EYE INSTITUTE OF BRANSON LLC
Other - Org Name:MISSOURI EYE INSTITUTE OF BRANSON LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-887-3900
Mailing Address - Street 1:1531 EAST BRADFORD PARKWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6539
Mailing Address - Country:US
Mailing Address - Phone:417-887-3900
Mailing Address - Fax:417-828-2894
Practice Address - Street 1:1000 JAMES F EPPS ROAD
Practice Address - Street 2:STE 2
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-334-5752
Practice Address - Fax:417-334-5765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI EYE INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015311OtherMEDICARE PTAN
MO1932232345OtherNPI
MO000015311Medicare PIN
MO000015311OtherMEDICARE PTAN