1053454728 NPI number — SEDALIA EYE ASSOCIATES, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053454728 NPI number — SEDALIA EYE ASSOCIATES, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEDALIA EYE ASSOCIATES, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053454728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 W 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDALIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65301-2198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-827-1120
Provider Business Mailing Address Fax Number:
660-827-2756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 COMERCIAL ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65355-1599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-438-6699
Provider Business Practice Location Address Fax Number:
660-438-4450
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
MARK
Authorized Official Middle Name:
TAYLOR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
660-438-6699

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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