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General NPI Number Information
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NPI Number | 1538563895
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Entity Type | Organization
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Legal Business Name | VISION THERAPY CENTER OF JONESBORO, P.L.L.C.
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 3705 E JOHNSON AVE SUITE B
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City | JONESBORO
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State | AR
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Zip | 72401-1858
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Country | US
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Telephone | 870-336-0387
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Fax | 870-336-2455
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Provider Business Mailing Address
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Address Line | 3705 E JOHNSON AVE SUITE B
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City | JONESBORO
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State | AR
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Zip | 72401-1858
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Country | US
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Telephone | 870-336-0387
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Fax | 870-336-2455
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MEGAN MOLL
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Credential | O.D
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Telephone | 870-336-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 2591
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 2628
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License Number State | AR
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