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General NPI Number Information
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NPI Number | 1518290303
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Entity Type | Organization
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Legal Business Name | MI MI OPTOMETRIC CENTER INC
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 9636 GARDEN GROVE BLVD STE 5
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City | GARDEN GROVE
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State | CA
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Zip | 92844
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Country | US
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Telephone | 714-537-1313
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Fax | 714-537-9180
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Provider Business Mailing Address
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Address Line | 9636 GARDEN GROVE BLVD STE 5
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1590
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Country | US
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Telephone | 714-537-1313
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Fax | 714-537-9180
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Authorized Official
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Title or Position | OD
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Name | DR. SHERYN S LEE
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Credential | OD
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Telephone | 714-537-1313
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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 | 12426T
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License Number State | CA
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