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General NPI Number Information
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NPI Number | 1477518066
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Entity Type | Organization
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Legal Business Name | COVENANT EYE CARE, PA
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 2555 COURT DRIVE SUITE 150
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City | GASTONIA
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State | NC
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Zip | 28054-2187
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Country | US
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Telephone | 704-864-7789
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Fax | 704-864-4884
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Provider Business Mailing Address
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Address Line | 2555 COURT DRIVE SUITE 150
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City | GASTONIA
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State | NC
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Zip | 28054-2187
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Country | US
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Telephone | 704-864-7789
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Fax | 704-864-4884
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN EWING ALLF
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Credential | MD
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Telephone | 704-864-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 79553
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License Number State | NC
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