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General NPI Number Information
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NPI Number | 1023193026
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Entity Type | Organization
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Legal Business Name | SUMMERFIELD VISION CARE LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 201 SAND LAKE ROAD
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City | ONALASKA
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State | WI
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Zip | 54650
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Country | US
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Telephone | 608-787-7409
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Fax |
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Provider Business Mailing Address
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Address Line | 47403 QUEENS COVE CIR
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City | LA CRESCENT
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State | MN
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Zip | 55947-4142
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Country | US
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Telephone | 507-643-6978
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | KENT DOUGLAS SUMMERFIELD
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Credential | O.D.
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Telephone | 608-787-7409
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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 | WI 1950
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License Number State | WI
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