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General NPI Number Information
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NPI Number | 1093202723
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Entity Type | Organization
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Legal Business Name | PAUL MIKAILIAN AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 26471 CARL BOYER DR
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2996
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Country | US
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Telephone | 661-288-2068
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Fax |
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Provider Business Mailing Address
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Address Line | 10727 RUSSETT AVE
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City | SUNLAND
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State | CA
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Zip | 91040-2306
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Country | US
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Telephone | 818-913-5113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL LEON MIKAILAN
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Credential | OD
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Telephone | 818-913-5113
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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 | 14631TLG
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License Number State | CA
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