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General NPI Number Information
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NPI Number | 1265513337
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Entity Type | Individual
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Provider Name | WILLIAM KYLE BOONE O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3795 BUFORD DRIVE WALMART VISION CENTER
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City | BUFORD
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State | GA
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Zip | 30519
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Country | US
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Telephone | 770-271-8084
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Fax |
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Provider Business Mailing Address
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Address Line | 1329 AVALON PL NE
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City | ATLANTA
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State | GA
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Zip | 30306-3327
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Country | US
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Telephone | 404-870-0509
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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 | 001374
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License Number State | GA
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