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General NPI Number Information
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NPI Number | 1225181951
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Entity Type | Individual
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Provider Name | JAMES VAN PHUNG OD.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 732 CENTER DR.
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City | SAN MARCOS
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State | CA
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Zip | 92069
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Country | US
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Telephone | 760-839-5161
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Fax | 760-741-7160
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Provider Business Mailing Address
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Address Line | 10050 SCRIPPS VISTA WAY UNIT 28
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City | SAN DIEGO
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State | CA
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Zip | 92131
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Country | US
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Telephone | 858-401-9088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12721
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License Number State | CA
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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 | 12721T
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License Number State | CA
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