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General NPI Number Information
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NPI Number | 1346235603
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Entity Type | Organization
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Legal Business Name | SHASTA EYE MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 3190 CHURN CREEK RD
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City | REDDING
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State | CA
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Zip | 96002-2122
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Country | US
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Telephone | 530-223-2500
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Fax | 530-226-1375
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Provider Business Mailing Address
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Address Line | PO BOX 398986
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City | SAN FRANCISCO
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State | CA
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Zip | 94139-5898
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Country | US
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Telephone | 530-223-2500
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Fax | 530-226-1375
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MR. GEORGE NEAL
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Credential |
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Telephone | 844-377-6468
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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