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General NPI Number Information
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NPI Number | 1316087117
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Entity Type | Organization
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Legal Business Name | CENTER FOR EYE CARE & SURGERY PC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 1501 COURT ST
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City | PUEBLO
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State | CO
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Zip | 81003-2720
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Country | US
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Telephone | 719-546-3937
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Fax | 719-546-3940
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Provider Business Mailing Address
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Address Line | 1501 COURT ST
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City | PUEBLO
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State | CO
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Zip | 81003-2720
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Country | US
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Telephone | 719-546-3937
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Fax | 719-546-3940
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES B FOWLER
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Credential | MD
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Telephone | 719-546-3937
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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 | 25573
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License Number State | CO
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