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General NPI Number Information
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NPI Number | 1194107078
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Entity Type | Organization
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Legal Business Name | BRAY SHEPHERD EYE CARE PC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 16637 E 23RD ST S
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City | INDEPENDENCE
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State | MO
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Zip | 64055-1922
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Country | US
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Telephone | 816-461-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 16637 E 23RD ST S
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City | INDEPENDENCE
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State | MO
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Zip | 64055-1922
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Country | US
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Telephone | 816-461-6880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCIA E BRAY
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Credential | D.O.
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Telephone | 816-461-6880
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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 | T03197
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License Number State | MO
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