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General NPI Number Information
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NPI Number | 1215312343
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Entity Type | Organization
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Legal Business Name | OPTIMAL VISION HEALTH, LLC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 1489 E SUMNER ST
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City | HARTFORD
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State | WI
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Zip | 53027-2606
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Country | US
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Telephone | 262-673-7737
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Fax | 262-673-7702
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Provider Business Mailing Address
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Address Line | 1489 E SUMNER ST
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City | HARTFORD
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State | WI
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Zip | 53027-2606
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Country | US
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Telephone | 262-673-7737
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Fax | 262-673-7702
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE KWON
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Credential | O.D.
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Telephone | 414-345-0547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3372-35
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License Number State | WI
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