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General NPI Number Information
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NPI Number | 1386614303
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Entity Type | Organization
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Legal Business Name | SUN EYE CARE PA
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 5920 CROMO DR
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City | EL PASO
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State | TX
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Zip | 79912-5526
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Country | US
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Telephone | 915-532-3697
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Fax | 915-532-3506
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Provider Business Mailing Address
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Address Line | 5920 CROMO DR
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City | EL PASO
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State | TX
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Zip | 79912-5526
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Country | US
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Telephone | 915-532-3697
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Fax | 915-532-3506
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL W FOOTE
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Credential | MD
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Telephone | 915-532-3697
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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 | 3753-T
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License Number State | TX
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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 | K8901
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License Number State | TX
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