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General NPI Number Information
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NPI Number | 1184916587
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Entity Type | Organization
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Legal Business Name | SUMMIT EYE & OPTICAL LLC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 323 SPRINGFIELD AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-3626
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Country | US
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Telephone | 908-918-0377
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Fax | 908-918-0109
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Provider Business Mailing Address
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Address Line | 323 SPRINGFIELD AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-3626
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Country | US
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Telephone | 908-918-0377
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Fax | 908-918-0109
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD J SEILER
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Credential | OD
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Telephone | 908-918-0377
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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 | 27OA00419700
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License Number State | NJ
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