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General NPI Number Information
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NPI Number | 1225210792
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Entity Type | Organization
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Legal Business Name | CHARLES R SANDERS
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 1400 LOWES BLVD
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City | KILLEEN
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State | TX
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Zip | 76542-5201
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Country | US
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Telephone | 254-200-1165
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Fax | 254-637-1800
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | HENDERSON
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State | TX
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Zip | 75653-0337
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Country | US
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Telephone | 903-854-2192
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Fax | 903-854-2407
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JO SANDERS
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Credential |
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Telephone | 903-854-2192
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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 | 2907TG
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License Number State | TX
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