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General NPI Number Information
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NPI Number | 1083890172
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Entity Type | Organization
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Legal Business Name | SUPERIOR VISION, LLC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 10922 E COUNTY ROAD 800 S STE A
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City | CAMBY
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State | IN
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Zip | 46113-9161
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Country | US
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Telephone | 317-856-2000
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Fax | 317-865-2000
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Provider Business Mailing Address
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Address Line | 8190 WINDFALL LN STE C
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City | CAMBY
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State | IN
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Zip | 46113-7906
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Country | US
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Telephone | 317-856-2000
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Fax | 317-865-2000
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Authorized Official
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Title or Position | O.D./PRESIDENT
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Name | DR. DIANNE E PORTER
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Credential |
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Telephone | 812-320-4362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 18002637B
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License Number State | IN
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