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General NPI Number Information
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NPI Number | 1265083455
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Entity Type | Organization
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Legal Business Name | I CARE VISION ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 2829 E OAKLAND AVE STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1908
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Country | US
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Telephone | 423-283-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 2829 E OAKLAND AVE STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1908
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Country | US
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Telephone | 423-283-4590
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST, MANAGING MEMBER
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Name | DR. JORDAN DANIEL HARRISON
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Credential | OD
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Telephone | 423-223-8676
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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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