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General NPI Number Information
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NPI Number | 1417456195
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Entity Type | Organization
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Legal Business Name | PALOS VISION CARE, INC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 11749 SOUTHWEST HWY STE D
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1053
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Country | US
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Telephone | 708-361-5236
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Fax | 708-361-5489
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Provider Business Mailing Address
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Address Line | 11749 SOUTHWEST HWY STE D
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1053
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Country | US
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Telephone | 708-361-5236
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Fax | 708-361-5489
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD L MONTWILL
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Credential | OD
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Telephone | 708-789-0356
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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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