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General NPI Number Information
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NPI Number | 1174651483
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Entity Type | Organization
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Legal Business Name | FAMILY VISION CARE OPTOMETRY OF MODESTO
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 817 COFFEE RD BUILDING D
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City | MODESTO
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State | CA
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Zip | 95355-4241
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Country | US
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Telephone | 209-524-9291
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Fax | 209-524-6362
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Provider Business Mailing Address
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Address Line | 817 COFFEE RD BUILDING D
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City | MODESTO
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State | CA
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Zip | 95355-4241
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Country | US
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Telephone | 209-524-9291
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Fax | 209-524-6362
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELDON LANG ROSENOW
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Credential | OD
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Telephone | 209-524-9291
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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 | CA
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