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General NPI Number Information
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NPI Number | 1003112012
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Entity Type | Organization
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Legal Business Name | VISION REHABILITATION CENTER OF THE OZARKS
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 1661 WEST ELFINDALE
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City | SPRINGFIELD
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State | MO
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Zip | 65807-1287
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Country | US
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Telephone | 417-831-0555
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Fax | 417-831-0532
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Provider Business Mailing Address
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Address Line | 1661 WEST ELFINDALE
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City | SPRINGFIELD
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State | MO
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Zip | 65807-1287
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Country | US
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Telephone | 417-831-0555
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Fax | 417-831-0532
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. JACQUELINE V. CRAIG
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Credential |
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Telephone | 417-831-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T03116
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | T03116
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License Number State | MO
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