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General NPI Number Information
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NPI Number | 1053514166
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Entity Type | Organization
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Legal Business Name | HOUCK EYE CARE AND REFRACTIVE SURGERY CENTER, PC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 2940 MOUNT CLAIR WAY
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City | LONG BEACH
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State | IN
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Zip | 46360-1769
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Country | US
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Telephone | 219-874-8086
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Fax | 219-879-5013
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Provider Business Mailing Address
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Address Line | PO BOX 9006
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City | MICHIGAN CITY
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State | IN
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Zip | 46361-9006
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Country | US
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Telephone | 219-874-8086
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Fax | 219-879-5013
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD JAMES HOUCK
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Credential | M.D.
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Telephone | 219-874-8086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01018052A
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License Number State | IN
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