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General NPI Number Information
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NPI Number | 1508902909
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Entity Type | Organization
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Legal Business Name | CEDAR CREST VISION CARE, PC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 1251 S CEDAR CREST BLVD SUITE 101A
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City | ALLENTOWN
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State | PA
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Zip | 18103-6205
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Country | US
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Telephone | 610-435-5561
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Fax | 610-435-5565
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Provider Business Mailing Address
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Address Line | 1251 S CEDAR CREST BLVD SUITE 101A
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City | ALLENTOWN
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State | PA
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Zip | 18103-6205
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Country | US
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Telephone | 610-435-5561
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Fax | 610-435-5565
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN KIM SOLAN
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Credential | OD
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Telephone | 610-435-5561
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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 | OEG001756
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License Number State | PA
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