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General NPI Number Information
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NPI Number | 1356386155
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Entity Type | Organization
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Legal Business Name | FAMILY FOCUSED VISION CARE, LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | W575 CASTLE DR.
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City | SHERWOOD
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State | WI
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Zip | 54169
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Country | US
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Telephone | 920-989-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 957 MELISSA ST
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City | MENASHA
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State | WI
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Zip | 54952-2013
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Country | US
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Telephone | 920-751-8824
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARIN MARIE LA COUNT
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Credential | O.D.
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Telephone | 920-989-2012
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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 | 2614
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License Number State | WI
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