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General NPI Number Information
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NPI Number | 1306928064
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Entity Type | Organization
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Legal Business Name | OPHTHALMOLOGY INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1300 STATE ST STE. 1-F
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City | LA PORTE
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State | IN
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Zip | 46350-3185
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Country | US
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Telephone | 219-362-6297
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Fax | 219-324-3061
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Provider Business Mailing Address
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Address Line | 1300 STATE ST STE. 1F
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City | LA PORTE
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State | IN
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Zip | 46350-3185
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Country | US
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Telephone | 219-362-6297
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Fax | 219-324-3061
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. BENJAMIN C MANNIX
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Credential | M.D.
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Telephone | 219-362-6297
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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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Taxonomy #2
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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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