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General NPI Number Information
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NPI Number | 1134062698
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Entity Type | Organization
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Legal Business Name | CHINOOK EYE CENTER
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 419 PENNSYLVANIA ST
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City | CHINOOK
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State | MT
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Zip | 59523-9726
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Country | US
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Telephone | 801-400-2068
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 E 925 S
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City | CLEARFIELD
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State | UT
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Zip | 84015-2377
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Country | US
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Telephone | 801-400-2068
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JOHN PEREZ
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Credential | OD
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Telephone | 801-400-2068
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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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