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General NPI Number Information
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NPI Number | 1124192620
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Entity Type | Individual
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Provider Name | BENJAMIN FOULADIAN
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 403 N PACIFIC COAST HWY #108
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2839
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Country | US
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Telephone | 310-318-6665
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Fax | 310-318-7117
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Provider Business Mailing Address
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Address Line | 10660 WILSHIRE BLVD APT 608
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City | LOS ANGELES
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State | CA
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Zip | 90024-7348
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Country | US
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Telephone | 310-985-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT 9702
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | BOL5070
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License Number State | CA
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