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General NPI Number Information
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NPI Number | 1427198589
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Entity Type | Individual
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Provider Name | BEN EI LU O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3043 FOOTHILL BLVD STE 4
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City | LA CRESCENTA
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State | CA
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Zip | 91214-2784
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Country | US
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Telephone | 818-957-8942
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Fax | 818-957-7804
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Provider Business Mailing Address
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Address Line | 1036 S GRANDRIDGE AVE
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City | MONTEREY PARK
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State | CA
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Zip | 91754-4936
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Country | US
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Telephone | 626-573-0793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11014T
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License Number State | CA
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