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General NPI Number Information
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NPI Number | 1336236710
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Entity Type | Organization
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Legal Business Name | THE EYE SURGERY AND LASER CENTER
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 501 MARSHALL ST SUITE 604
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-985-9120
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Fax | 601-985-9122
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Provider Business Mailing Address
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Address Line | 501 MARSHALL ST SUITE 604
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-985-9120
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Fax | 601-985-9122
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WILLIAM C ASHFORD
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Credential | M.D.
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Telephone | 601-985-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 07279
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License Number State | MS
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