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General NPI Number Information
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NPI Number | 1447456876
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Entity Type | Organization
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Legal Business Name | BRUCE EYE CLINIC, INC
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 208 W. CALHOUN ST
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City | BRUCE
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State | MS
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Zip | 38915-0988
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Country | US
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Telephone | 662-983-2323
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Fax | 662-983-4126
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Provider Business Mailing Address
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Address Line | PO BOX 988
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City | BRUCE
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State | MS
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Zip | 38915-0988
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Country | US
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Telephone | 662-983-2323
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Fax | 662-983-4126
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Authorized Official
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Title or Position | OWNER
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Name | JAMES EDWARD BROWN
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Credential | OD
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Telephone | 662-983-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 577
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 577
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License Number State | MS
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