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General NPI Number Information
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NPI Number | 1609298876
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Entity Type | Organization
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Legal Business Name | CAPITOL EYECARE, SC
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 401 E CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53212-1211
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Country | US
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Telephone | 608-449-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 1719 MONROE ST SUITE 001
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City | MADISON
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State | WI
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Zip | 53711-2074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER ANDREAKOS
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Credential | OD
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Telephone | 608-449-3353
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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 | 2739
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License Number State | WI
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