| Mattax Neu Prater Eye Center, Inc. | |
|
430 N Jefferson Ave, Lebanon, MO 65536-2742 | |
| (417) 886-3937 | |
| (417) 886-1285 |
| Full Name | Mattax Neu Prater Eye Center, Inc. |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 430 N Jefferson Ave, Lebanon, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528163300 | NPI | - | NPPES |
| CI7182 | Other | MO | RAILROAD MEDICARE PART B |
| 505886200 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | Marla C Smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1093776098 PECOS PAC ID: 9234267295 Enrollment ID: I20100512000477 |
| Provider Name | Michael S Engleman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790754109 PECOS PAC ID: 2062540032 Enrollment ID: I20100512000611 |
| Provider Name | Leo T Neu |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1588632889 PECOS PAC ID: 0143325050 Enrollment ID: I20100512000782 |
| Provider Name | Thomas G Prater |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1043289119 PECOS PAC ID: 1052416963 Enrollment ID: I20100512000855 |
| Provider Name | Matthew T Smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1548239163 PECOS PAC ID: 6608904610 Enrollment ID: I20100512000937 |
| Provider Name | James B Mattax |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1346244779 PECOS PAC ID: 5597652370 Enrollment ID: I20100512000973 |
| Provider Name | Jacob K Thomas |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1538328489 PECOS PAC ID: 6305016775 Enrollment ID: I20120725000343 |
| Provider Name | Benjamin P Haden |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1952729600 PECOS PAC ID: 5991020950 Enrollment ID: I20180809006027 |
| Provider Name | David A Nasrazadani |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1922529536 PECOS PAC ID: 0547522310 Enrollment ID: I20220920001077 |
| Provider Name | Drew A Young |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1407411093 PECOS PAC ID: 6305207515 Enrollment ID: I20230804000393 |
| Mailing Address | Practice Location Address |
|---|---|
| Mattax Neu Prater Eye Center, Inc. 1265 E Primrose St, Springfield, MO 65804-4278 Ph: (417) 886-3937 | Mattax Neu Prater Eye Center, Inc. 430 N Jefferson Ave, Lebanon, MO 65536-2742 Ph: (417) 886-3937 |