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General NPI Number Information
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NPI Number | 1184134744
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Entity Type | Organization
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Legal Business Name | HOSS EYECARE, P.C.
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 500 E ALICE ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4998
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Country | US
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Telephone | 630-485-1369
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Fax |
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Provider Business Mailing Address
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Address Line | 3380 FRED GEORGE RD APT 704
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City | TALLAHASSEE
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State | FL
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Zip | 32303-1503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MATTHEW JACOBS
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Credential |
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Telephone | 630-485-1369
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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 | OPT003026
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License Number State | GA
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