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General NPI Number Information
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NPI Number | 1558564757
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CLINIC, INC.
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 115 W 7TH ST
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City | NEILLSVILLE
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State | WI
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Zip | 54456-1552
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Country | US
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Telephone | 715-743-3219
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 229
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City | NEILLSVILLE
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State | WI
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Zip | 54456-0229
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Country | US
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Telephone | 715-743-3219
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | R TIM HARVEY
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Credential | OD
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Telephone | 715-743-3219
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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 | 1378
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License Number State | WI
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