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General NPI Number Information
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NPI Number | 1528238854
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Entity Type | Organization
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Legal Business Name | FOX VALLEY OPHTHALMOLOGY
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 40W330 LAFOX RD
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City | ST CHARLES
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State | IL
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Zip | 60175-6515
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Country | US
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Telephone | 630-584-9850
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Fax | 630-584-1523
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Provider Business Mailing Address
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Address Line | 750 FLETCHER DR STE 106
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City | ELGIN
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State | IL
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Zip | 60123-4703
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Country | US
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Telephone | 847-695-0499
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Fax | 847-695-4339
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SUSAN C MOSS
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Credential |
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Telephone | 630-584-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 042002501
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License Number State | IL
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