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General NPI Number Information
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NPI Number | 1518204692
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Entity Type | Organization
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Legal Business Name | SUMMIT EYECARE, LLC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 22400 SALAMO RD SUITE 100
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City | WEST LINN
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State | OR
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Zip | 97068-8269
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Country | US
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Telephone | 503-722-7737
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Fax | 503-722-4152
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Provider Business Mailing Address
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Address Line | 22400 SALAMO RD SUITE 100
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City | WEST LINN
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State | OR
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Zip | 97068-8269
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Country | US
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Telephone | 503-722-7737
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Fax | 503-722-4152
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ERIN ANDERSON
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Credential | O.D.
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Telephone | 503-722-7737
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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 | 3380-AT
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License Number State | OR
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