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General NPI Number Information
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NPI Number | 1073710968
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Entity Type | Organization
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Legal Business Name | MEDICAL EYE CLINIC OF EAU CLAIRE
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 2715 DAMON ST SUITE 200
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2634
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Country | US
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Telephone | 715-834-5644
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Fax | 715-834-5674
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Provider Business Mailing Address
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Address Line | 2715 DAMON ST SUITE 200
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2634
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Country | US
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Telephone | 715-834-5644
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Fax | 715-834-5674
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROY A OLSON
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Credential | M.D.
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Telephone | 715-834-5644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 17337
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License Number State | WI
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