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General NPI Number Information
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NPI Number | 1609877083
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Entity Type | Organization
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Legal Business Name | JOHN KENYON EYE CENTER
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1305 WALL ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3853
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Country | US
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Telephone | 812-288-9011
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Fax | 812-288-7479
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Provider Business Mailing Address
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Address Line | 1305 WALL ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3853
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Country | US
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Telephone | 812-288-9011
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Fax | 812-288-7479
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Authorized Official
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Title or Position | CONTROLLER
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Name | MS. SHELLEY RENEE GAST
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Credential |
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Telephone | 812-258-3026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 15811
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01025213
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License Number State | IN
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