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General NPI Number Information
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NPI Number | 1508141995
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Entity Type | Organization
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Legal Business Name | FRONTIER EYE CARE LLC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 5880 E 2ND ST STE 100
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City | CASPER
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State | WY
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Zip | 82609-4389
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Country | US
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Telephone | 307-472-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50871
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City | CASPER
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State | WY
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Zip | 82605-0871
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Country | US
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Telephone | 307-277-5282
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DOUGLAS JOHN HODGSON
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Credential | O.D.
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Telephone | 307-277-5282
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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 | 268T
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License Number State | WY
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