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General NPI Number Information
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NPI Number | 1427149160
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN EYE CARE, INC.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 467 SUNSET TRAIL
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City | JELLICO
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State | TN
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Zip | 37762-2709
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Country | US
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Telephone | 423-784-2020
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Fax | 423-784-4940
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Provider Business Mailing Address
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Address Line | 127 FOOTHILLS AVE SUITE 3
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City | ALBANY
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State | KY
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Zip | 42602-1090
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Country | US
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Telephone | 606-387-5612
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Fax | 606-387-6602
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Authorized Official
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Title or Position | PRESIDENT AND AUTHORIZED OFFICIAL
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Name | GARY WALTER UPCHURCH
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Credential | OD
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Telephone | 606-387-5612
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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 | TN
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