Springfield Eye & Plastic Surgery

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

2004008249 Issued in MO

Legal business name

SPRINGFIELD EYE & PLASTIC SURGERY

Practice address

2828 N National Ave
Suite E
Springfield, MO 65803-4306

Phone

(417) 837-4238

Fax

(417) 875-4728

NPI assigned

May 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brendon Delport, D.O.

Title

Owner

Phone

(417) 496-3664

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363132800000",
    "number": "1821201641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657210070",
            "telephone_number": "417-837-4238",
            "fax_number": "417-875-4728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 N NATIONAL AVE",
            "address_2": "SUITE E",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034306",
            "telephone_number": "417-837-4238",
            "fax_number": "417-875-4728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD EYE & PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2013-03-13",
        "status": "A",
        "authorized_official_last_name": "DELPORT",
        "authorized_official_first_name": "BRENDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-496-3664",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2004008249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209165604",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1194721100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "DO5151",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Springfield Behavioral Hospital, LLC
• Springfield Celebrate Pediatrics LLC
• Springfield Dental Partners LLC
• Springfield Dentistry 4 Kids LLC
• Springfield Ear Nose Throat & Facial Plastic Surgery
• Springfield Eye Specialists LLC
• Springfield Eyecare, LLC
• Springfield Family Dental LLC
• Springfield Family Medical Walk-in Clinics Inc
• Springfield Family Vision

• Ophthalmology Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Ophthalmology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.