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General NPI Number Information
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NPI Number | 1053335695
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Entity Type | Organization
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Legal Business Name | FAMILY VISION CARE OPHTHALMIC DISPENSING LLC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 205 LAKE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2628
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Country | US
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Telephone | 518-584-6111
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Fax | 518-580-8589
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Provider Business Mailing Address
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Address Line | 205 LAKE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2628
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Country | US
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Telephone | 518-584-6111
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Fax | 518-580-8589
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN E HALSTEAD
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Credential | ABOC, FNAO
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Telephone | 518-584-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #2
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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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