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General NPI Number Information
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NPI Number | 1548256647
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Entity Type | Organization
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Legal Business Name | FAMILY VISION CENTER LLC
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 775 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06615-7406
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Country | US
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Telephone | 203-377-2020
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Fax | 203-381-9936
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Provider Business Mailing Address
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Address Line | 775 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06615-7406
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Country | US
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Telephone | 203-377-2020
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Fax | 203-381-9936
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J GORMAN
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Credential | OD
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Telephone | 203-377-2020
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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 | 000660
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License Number State | CT
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