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General NPI Number Information
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NPI Number | 1528627932
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Entity Type | Organization
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Legal Business Name | FAMILY EYE ASSOCIATES OPTOMETRIC GROUP, INC.
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 07/13/2019
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Provider Practice Location Address
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Address Line | 3700 HILBORN RD STE 500
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City | FAIRFIELD
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State | CA
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Zip | 94534-7997
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Country | US
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Telephone | 707-426-2020
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Fax | 707-426-9510
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Provider Business Mailing Address
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Address Line | 3700 HILBORN RD STE 500
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City | FAIRFIELD
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State | CA
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Zip | 94534-7997
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Country | US
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Telephone | 707-426-2020
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Fax | 707-426-9510
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Authorized Official
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Title or Position | OWNER
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Name | MALALAI S. MOJADDIDI
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Credential | OD
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Telephone | 707-426-2020
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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 |
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License Number State |
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