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General NPI Number Information
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NPI Number | 1124347513
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Entity Type | Organization
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Legal Business Name | EYECONIC EYECARE LLC
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 18931 E VALLEY VIEW PKWY SUITE H
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City | INDEPENDENCE
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State | MO
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Zip | 64055-7012
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Country | US
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Telephone | 816-795-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 18931 E VALLEY VIEW PKWY SUITE H
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City | INDEPENDENCE
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State | MO
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Zip | 64055-7012
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Country | US
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Telephone | 816-795-8884
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST / OWNER
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Name | DR. MICHAEL J HAWK
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Credential | O.D.
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Telephone | 816-308-9132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2004004593
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License Number State | MO
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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 |
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License Number State |
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