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General NPI Number Information
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NPI Number | 1497740872
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Entity Type | Organization
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Legal Business Name | SHASTA EYE SURGEONS INC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 950 BUTTE ST
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City | REDDING
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State | CA
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Zip | 96001-0827
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Country | US
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Telephone | 530-223-2500
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Fax | 530-241-1408
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Provider Business Mailing Address
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Address Line | 950 BUTTE ST
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City | REDDING
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State | CA
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Zip | 96001-0827
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Country | US
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Telephone | 530-223-2500
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Fax | 530-241-1408
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | GEORGE L NEAL
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Credential |
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Telephone | 844-377-6468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 051087
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 051087
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License Number State | CA
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