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General NPI Number Information
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NPI Number | 1174705438
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY EYECARE INC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 2245 LONG ST
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City | SWEET HOME
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State | OR
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Zip | 97386-2845
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Country | US
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Telephone | 541-367-2188
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Fax | 541-367-2189
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Provider Business Mailing Address
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Address Line | 38661 PALMYRE DR
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City | LEBANON
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State | OR
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Zip | 97355-9284
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Country | US
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Telephone | 541-401-4649
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Fax | 541-367-2189
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | MICHAEL WAYNE STONER
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Credential | O.D.
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Telephone | 541-367-2188
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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 | 2480ATI
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License Number State | OR
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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 | 2480ATI
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License Number State | OR
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