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General NPI Number Information
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NPI Number | 1205878915
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE VISION INSTITUTE OF PHILADELPHIA, PC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 100 E LEHIGH AVE 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19125-1012
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Country | US
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Telephone | 215-707-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1901
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Country | US
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Telephone | 215-745-5050
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Fax | 215-342-4007
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Authorized Official
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Title or Position | OWNER
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Name | SOLOMON LUO
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Credential | MD
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Telephone | 215-707-1830
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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 |
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License Number State | PA
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