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General NPI Number Information
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NPI Number | 1073572806
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Entity Type | Individual
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Provider Name | MICHAEL LOCKHART JR. OD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 915 LINCOLN WAY E
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City | MASSILLON
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State | OH
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Zip | 44646-6833
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Country | US
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Telephone | 330-833-1091
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Fax | 330-833-1092
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Provider Business Mailing Address
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Address Line | 1151 MELSCHEIMER RD SW
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City | EAST SPARTA
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State | OH
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Zip | 44626-9752
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Country | US
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Telephone | 330-484-3203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5601
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License Number State | OH
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