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General NPI Number Information
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NPI Number | 1306827837
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Entity Type | Organization
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Legal Business Name | GAYLORD EYE CARE CENTER INC
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 829 W MAIN ST SUITE E
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City | GAYLORD
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State | MI
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Zip | 49735-1998
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Country | US
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Telephone | 989-732-6261
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Fax | 989-732-1276
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Provider Business Mailing Address
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Address Line | 829 W MAIN ST SUITE E
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City | GAYLORD
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State | MI
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Zip | 49735-1998
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Country | US
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Telephone | 989-732-6261
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Fax | 989-732-1276
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD L MEAD
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Credential | OD
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Telephone | 989-732-6261
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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 | 4901004573
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901002759
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003033
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003972
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License Number State | MI
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