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General NPI Number Information
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NPI Number | 1437138203
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Entity Type | Organization
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Legal Business Name | PAUL V HAKES OD INC
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 204 LENORA ST
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City | MCCALL
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State | ID
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Zip | 83638
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Country | US
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Telephone | 208-634-2232
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Fax | 208-634-4716
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Provider Business Mailing Address
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Address Line | PO BOX 1027
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City | MCCALL
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State | ID
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Zip | 83638-1027
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Country | US
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Telephone | 208-634-2232
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Fax | 208-634-1746
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Authorized Official
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Title or Position | OWNER
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Name | PAUL V HAKES
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Credential | OD
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Telephone | 208-634-2232
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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 | 04761969
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License Number State | ID
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