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General NPI Number Information
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NPI Number | 1003487067
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE VISION PLLC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 2405 REITH WAY STE 1
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City | SUNNYSIDE
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State | WA
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Zip | 98944-9536
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Country | US
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Telephone | 509-839-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 294
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City | SELAH
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State | WA
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Zip | 98942-0294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRETT MOWER
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Credential |
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Telephone | 509-307-7012
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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 |
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License Number State |
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