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General NPI Number Information
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NPI Number | 1255815205
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Entity Type | Organization
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Legal Business Name | LINN COUNTY VISION CENTER, LLC
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Dates
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Enumeration Date | 09/16/2018
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Last Update Date | 09/16/2018
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Provider Practice Location Address
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Address Line | 2169 14TH AVE SE
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City | ALBANY
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State | OR
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Zip | 97322-8510
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Country | US
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Telephone | 541-928-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 CLOUDBURST AVE NW
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City | SALEM
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State | OR
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Zip | 97304-2818
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Country | US
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Telephone | 760-261-8339
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Fax |
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Authorized Official
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Title or Position | OWNER AND SOLE MEMBER OF LLC
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Name | DR. JASON DROBECK
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Credential | OD
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Telephone | 760-261-8339
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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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