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General NPI Number Information
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NPI Number | 1225155435
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CARE
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 323 MAIN ST
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City | SACO
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State | ME
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Zip | 04072-1514
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Country | US
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Telephone | 207-284-4560
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Fax | 207-283-0309
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Provider Business Mailing Address
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Address Line | 323 MAIN ST
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City | SACO
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State | ME
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Zip | 04072-1514
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Country | US
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Telephone | 207-284-4560
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Fax | 207-283-0309
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Authorized Official
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Title or Position | OWNER AND PROVIDER
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Name | KERRY CONNELL
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Credential | OD
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Telephone | 207-284-4560
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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 |
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License Number State |
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