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General NPI Number Information
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NPI Number | 1164611133
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Entity Type | Organization
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Legal Business Name | HOQUIAM VISION CLINIC PS
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 403 7TH ST
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City | HOQUIAM
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State | WA
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Zip | 98550-3615
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Country | US
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Telephone | 360-533-7395
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Fax | 360-532-6907
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Provider Business Mailing Address
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Address Line | 403 7TH ST
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City | HOQUIAM
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State | WA
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Zip | 98550-3615
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Country | US
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Telephone | 360-533-7395
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Fax | 360-532-6907
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. EDWARD J WAYMAN
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Credential | O.D.
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Telephone | 360-533-7395
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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 | OD00001404
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License Number State | WA
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