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General NPI Number Information
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NPI Number | 1548329097
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Entity Type | Organization
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Legal Business Name | ANGEL OAK EYE CENTER
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 2875 MAYBANK HWY
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-4808
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Country | US
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Telephone | 843-559-5333
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Fax | 843-559-5339
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Provider Business Mailing Address
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Address Line | PO BOX 874
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City | JOHNS ISLAND
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State | SC
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Zip | 29457-0874
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Country | US
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Telephone | 843-559-5333
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Fax | 843-559-5339
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Authorized Official
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Title or Position | OWNER
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Name | PAUL W BOHAC
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Credential | O.D.
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Telephone | 843-559-5333
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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 | 907
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License Number State | SC
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