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General NPI Number Information
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NPI Number | 1134697089
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Entity Type | Organization
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Legal Business Name | WESTERN NEW YORK FAMILY EYECARE LLC
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 12/14/2018
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Provider Practice Location Address
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Address Line | 4960 TRANSIT ROAD SUITE 1
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City | DEPEW
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State | NY
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Zip | 14043-4655
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Country | US
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Telephone | 716-462-8519
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 TRANSIT RD STE 1
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City | DEPEW
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State | NY
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Zip | 14043-4655
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Country | US
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Telephone | 716-462-8519
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH JAMES CAMPESE
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Credential | OD
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Telephone | 716-462-8519
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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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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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