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General NPI Number Information
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NPI Number | 1114062635
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Entity Type | Organization
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Legal Business Name | LIVERMORE OPTOMETRY GROUP
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 1800 4TH ST
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City | LIVERMORE
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State | CA
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Zip | 94550-4454
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Country | US
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Telephone | 925-447-3883
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Fax | 925-447-2957
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Provider Business Mailing Address
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Address Line | 1800 4TH ST
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City | LIVERMORE
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State | CA
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Zip | 94550-4454
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Country | US
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Telephone | 925-447-3883
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Fax | 925-447-2957
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN FAITH
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Credential | OD
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Telephone | 925-447-3883
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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 | CA
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