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General NPI Number Information
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NPI Number | 1437398047
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Entity Type | Organization
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Legal Business Name | SMITH VISION, LLC
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 3961 E CHANDLER BLVD SUITE 106
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City | PHOENIX
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State | AZ
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Zip | 85048-0303
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Country | US
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Telephone | 480-706-3060
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Fax | 480-706-3065
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Provider Business Mailing Address
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Address Line | 3961 E CHANDLER BLVD SUITE 106
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City | PHOENIX
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State | AZ
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Zip | 85048-0303
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Country | US
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Telephone | 480-706-3060
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Fax | 480-706-3065
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ALEX J SMITH
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Credential | O.D.
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Telephone | 480-706-3060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1570
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License Number State | AZ
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