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General NPI Number Information
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NPI Number | 1235541103
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Entity Type | Organization
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Legal Business Name | SPECX WEST LLC
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 2148 45TH ST FL2
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City | ASTORIA
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State | NY
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Zip | 11105-1302
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Country | US
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Telephone | 805-280-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S RIDGE ST
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City | RYE BROOK
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State | NY
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Zip | 10573-3434
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Country | US
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Telephone | 805-280-1776
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. ERIC CHARLES RUBINFELD
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Credential | OD
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Telephone | 805-280-1776
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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 | NY004855
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License Number State | NY
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