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General NPI Number Information
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NPI Number | 1083962781
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Entity Type | Organization
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Legal Business Name | SUZANNE M HAZEN PC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 220 E COLORADO AVE 210
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City | TELLURIDE
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State | CO
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Zip | 81435
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Country | US
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Telephone | 970-708-4890
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Fax | 970-728-8987
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Provider Business Mailing Address
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Address Line | PO BOX 3110
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City | TELLURIDE
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State | CO
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Zip | 81435-3110
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Country | US
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Telephone | 970-708-4890
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Fax | 970-728-8987
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZANNE MCLEAN HAZEN
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Credential | OD
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Telephone | 970-708-4890
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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 |
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License Number State |
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