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General NPI Number Information
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NPI Number | 1114205788
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Entity Type | Organization
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Legal Business Name | TRI STATE VISION CARE, PROF LLC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 1601 CORNHUSKER DR
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City | SOUTH SIOUX CITY
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State | NE
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Zip | 68776-3924
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Country | US
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Telephone | 402-494-1498
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Fax | 402-494-1594
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Provider Business Mailing Address
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Address Line | 2709 ABBOTT CIR
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City | YANKTON
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State | SD
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Zip | 57078-5330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LAURA JOAN SLOWEY
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Credential | O.D.
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Telephone | 605-660-3896
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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 | 1355
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License Number State | NE
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