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General NPI Number Information
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NPI Number | 1578097259
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Entity Type | Organization
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Legal Business Name | EYECARE OF LIVONIA PLLC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 13700 MIDDLEBELT RD
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City | LIVONIA
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State | MI
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Zip | 48150-2215
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Country | US
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Telephone | 734-427-2944
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Fax | 734-853-3798
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Provider Business Mailing Address
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Address Line | 5016 WAVEWOOD DR
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-1362
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Country | US
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Telephone | 249-249-4793
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. WILLIAM JOHN KIEFIUK
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Credential | O.D.
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Telephone | 249-249-4793
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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 | 4901003019
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License Number State | MI
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