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General NPI Number Information
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NPI Number | 1215205679
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Entity Type | Organization
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Legal Business Name | EXODUS VISION, LLC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 1260 LYELL AVE
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City | ROCHESTER
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State | NY
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Zip | 14606-2040
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Country | US
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Telephone | 585-254-0022
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Fax | 585-254-0132
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Provider Business Mailing Address
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Address Line | 2191 COLUMBIA AVE W
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City | BATTLE CREEK
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State | MI
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Zip | 49015-2847
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Country | US
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Telephone | 269-968-1600
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Fax | 269-968-1600
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Authorized Official
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Title or Position | CEO
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Name | MR. PATRICK HO
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Credential |
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Telephone | 585-254-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | MI
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