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General NPI Number Information
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NPI Number | 1366670689
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Entity Type | Organization
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Legal Business Name | ISLAND EYECARE
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 1429 HIGH STREET
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City | ALAMEDA
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State | CA
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Zip | 94501
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Country | US
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Telephone | 510-522-5097
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Fax | 510-522-0815
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Provider Business Mailing Address
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Address Line | 1429 HIGH ST
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City | ALAMEDA
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State | CA
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Zip | 94501-3102
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Country | US
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Telephone | 510-522-5097
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Fax | 510-522-0815
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLOTTE A TLACHAC
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Credential | O.D.
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Telephone | 510-522-5097
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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 | 6573T
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License Number State | CA
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