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General NPI Number Information
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NPI Number | 1477727964
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Entity Type | Organization
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Legal Business Name | PREMIER OPHTHALMIC DISPENSARY LLC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 11 MOUNTAIN ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-8586
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Country | US
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Telephone | 706-632-6989
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Fax | 706-632-7478
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Provider Business Mailing Address
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Address Line | 11 MOUNTAIN ST STE.3
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City | BLUE RIDGE
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State | GA
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Zip | 30513-8586
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Country | US
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Telephone | 706-632-6989
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Fax | 706-632-7478
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINDA A SZEKERESH
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Credential | D.O.
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Telephone | 706-632-6989
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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 | 049674
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License Number State | GA
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