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General NPI Number Information
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NPI Number | 1477785772
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Entity Type | Organization
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Legal Business Name | SOUTH BAY EYE CARE OPTOMETRY, INC
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 2245 LOMITA BLVD
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City | LOMITA
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State | CA
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Zip | 90717-1437
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Country | US
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Telephone | 310-534-1873
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Fax | 310-534-8926
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Provider Business Mailing Address
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Address Line | 2245 LOMITA BLVD
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City | LOMITA
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State | CA
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Zip | 90717-1437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZEN-NI SU
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Credential | O.D.
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Telephone | 310-534-1873
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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 | 12006T
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License Number State | CA
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