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General NPI Number Information
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NPI Number | 1356911689
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Entity Type | Organization
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Legal Business Name | INDY VISION CARE LLC
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 639 S DELAWARE ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46225-1392
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Country | US
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Telephone | 317-277-3218
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Fax | 317-296-7169
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Provider Business Mailing Address
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Address Line | 639 S DELAWARE ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46225-1392
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Country | US
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Telephone | 317-277-3218
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Fax | 317-296-7169
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LORI WILSON
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Credential |
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Telephone | 317-653-5872
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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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