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General NPI Number Information
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NPI Number | 1316588700
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Entity Type | Organization
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Legal Business Name | TOTAL VISION EYECARE, PLLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 1630 CENTER ST W
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City | ROCHESTER
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State | MN
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Zip | 55902-0346
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Country | US
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Telephone | 570-218-9357
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Fax |
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Provider Business Mailing Address
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Address Line | 6449 SUMMIT POINTE RD NW
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City | ROCHESTER
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State | MN
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Zip | 55901-5657
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Country | US
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Telephone | 570-218-9357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE EDWARD ADDISON II
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Credential | OD
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Telephone | 570-218-9357
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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 |
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License Number State |
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