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General NPI Number Information
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NPI Number | 1346217536
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Entity Type | Organization
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Legal Business Name | MOORE VISION P.C. DBA PREMIER FAMILY EYECARE
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 1123 EAGLE DR
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City | LOVELAND
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State | CO
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Zip | 80537-8020
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Country | US
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Telephone | 970-622-0646
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 EAGLE DR
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City | LOVELAND
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State | CO
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Zip | 80537-8020
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Country | US
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Telephone | 970-622-0646
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Fax |
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Authorized Official
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Title or Position | V.P./OPTOMETRIST
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Name | DR. DIANA LYNNE MOORE
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Credential | O.D.
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Telephone | 970-622-0646
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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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