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General NPI Number Information
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NPI Number | 1174807903
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Entity Type | Organization
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Legal Business Name | CENTER FOR MISALIGNED EYES PA
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 8222 DOUGLAS AVE SUITE 400
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City | DALLAS
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State | TX
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Zip | 75225-5923
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Country | US
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Telephone | 214-369-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 8222 DOUGLAS AVE SUITE 400
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City | DALLAS
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State | TX
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Zip | 75225-5923
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Country | US
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Telephone | 214-369-6434
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID R STAGER
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Credential | MD
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Telephone | 214-369-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D5479
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License Number State | TX
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