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General NPI Number Information
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NPI Number | 1518513613
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Entity Type | Organization
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Legal Business Name | HENDRIX EYE CLINIC, LLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 864 CENTRAL AVE
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City | DEMOREST
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State | GA
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Zip | 30535-5534
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Country | US
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Telephone | 706-778-0101
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Fax | 706-778-0082
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | DEMOREST
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State | GA
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Zip | 30535-0100
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Country | US
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Telephone | 706-969-2565
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Fax | 706-778-0082
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Authorized Official
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Title or Position | OPTOMETRIST/ORGANIZER
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Name | DR. JOHN PERRY HENDRIX
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Credential | O.D.
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Telephone | 706-969-2565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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