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General NPI Number Information
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NPI Number | 1316221831
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Entity Type | Organization
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Legal Business Name | MELINDA S. LEGG OD
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 2730 N WEST AVE
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City | EL DORADO
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State | AR
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Zip | 71730-3124
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Country | US
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Telephone | 870-862-8069
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 196
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City | JUNCTION CITY
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State | AR
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Zip | 71749-0196
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Country | US
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Telephone | 870-862-8069
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELINDA SUE LEGG
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Credential | O.D.
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Telephone | 870-312-0332
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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 | 2608
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License Number State | AR
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