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General NPI Number Information
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NPI Number | 1205871928
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Entity Type | Organization
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Legal Business Name | PREMIUM EYE CARE, PC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 738 HIGH ST
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City | WESTWOOD
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State | MA
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Zip | 02090-2503
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Country | US
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Telephone | 781-329-5454
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Fax | 781-329-7813
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Provider Business Mailing Address
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Address Line | 738 HIGH ST
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City | WESTWOOD
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State | MA
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Zip | 02090-2503
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Country | US
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Telephone | 781-329-5454
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Fax | 781-329-7813
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Authorized Official
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Title or Position | OD, OWNER
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Name | CORY LAVALLEE
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Credential | OD
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Telephone | 781-329-5454
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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 | 3168
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License Number State | MA
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