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General NPI Number Information
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NPI Number | 1396733945
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Entity Type | Organization
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Legal Business Name | EYE LASER & SURGERY CENTER OF COLUMBUS, LLC
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 634 LEIGH DR
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City | COLUMBUS
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State | MS
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Zip | 39705-3014
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Country | US
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Telephone | 662-327-3773
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Fax | 662-327-3996
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Provider Business Mailing Address
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Address Line | 634 LEIGH DR
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City | COLUMBUS
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State | MS
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Zip | 39705-3014
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Country | US
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Telephone | 662-327-3773
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Fax | 662-327-3996
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. RENEE OWEN
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Credential | R.N.
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Telephone | 662-327-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | MS
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