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General NPI Number Information
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NPI Number | 1548515661
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Entity Type | Organization
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Legal Business Name | I VISION OPTOMETRY, INC
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Dates
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Enumeration Date | 07/14/2012
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Last Update Date | 07/14/2012
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Provider Practice Location Address
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Address Line | 2829 PACIFIC COAST HWY
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City | TORRANCE
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State | CA
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Zip | 90505-6701
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Country | US
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Telephone | 310-530-2829
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Fax |
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Provider Business Mailing Address
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Address Line | 2829 PACIFIC COAST HWY
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City | TORRANCE
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State | CA
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Zip | 90505-6701
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Country | US
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Telephone | 310-530-2829
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. IKUKO SUGIMOTO
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Credential | O.D.
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Telephone | 310-530-2829
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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 | 10387T
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License Number State | CA
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