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General NPI Number Information
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NPI Number | 1114626777
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Entity Type | Organization
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Legal Business Name | LEGACY WEST TEXAS EYE CARE
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 7500 WINDROSE AVE UNIT B180
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City | PLANO
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State | TX
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Zip | 75024-0163
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Country | US
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Telephone | 469-931-2138
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Fax | 469-931-2152
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Provider Business Mailing Address
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Address Line | 7500 WINDROSE AVE UNIT B180
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City | PLANO
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State | TX
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Zip | 75024-0163
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Country | US
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Telephone | 469-931-2138
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Fax | 469-931-2152
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN ANDERSON
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Credential | OD
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Telephone | 801-368-8247
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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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