Basic Information
| Provider Information | |||||||||
| NPI: | 1346244779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTAX | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1265 E PRIMROSE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178863937 | ||||||||
| FaxNumber: | 4178861825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 E PRIMROSE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178863937 | ||||||||
| FaxNumber: | 4178861285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | R9H41 | MO | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 202545034 | 05 | MO | MEDICAID | 202545026 | 05 | MO | MEDICAID | 0840001 | 01 | MO | UNITED HC OF MIDWEST | OTHER | 32245 | 01 | MO | OPTICARE | OTHER | 118132 | 01 | MO | BLUE CROSS/SHIELD ST.LOU | OTHER | 822629 | 01 | MO | HEALTHCARE PREFERRED | OTHER | 1402 | 01 | MO | COX HEALTH INS | OTHER |