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General NPI Number Information
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NPI Number | 1275175119
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Entity Type | Organization
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Legal Business Name | SUMMIT EYE CARE OF MINNESOTA SC
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N STE 140
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2961
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Country | US
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Telephone | 612-445-9110
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Fax | 952-479-5287
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Provider Business Mailing Address
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Address Line | 5715 W OLD SHAKOPEE RD # 150
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City | BLOOMINGTON
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State | MN
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Zip | 55437-3107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN A VUKICH
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Credential | MD
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Telephone | 608-220-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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