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General NPI Number Information
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NPI Number | 1598714008
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Entity Type | Organization
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Legal Business Name | LYNDON GRAVES, P.C.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 9239 W CENTER RD SUITE 103
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City | OMAHA
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State | NE
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Zip | 68124-1933
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Country | US
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Telephone | 402-898-3232
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Fax | 402-898-3234
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Provider Business Mailing Address
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Address Line | 9239 W CENTER RD SUITE 103
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City | OMAHA
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State | NE
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Zip | 68124-1933
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Country | US
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Telephone | 402-898-3232
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Fax | 402-898-3234
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | LYNDON JAY GRAVES
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Credential | O.D.
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Telephone | 402-898-3232
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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 | 998
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License Number State | NE
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