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General NPI Number Information
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NPI Number | 1619064177
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Entity Type | Organization
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Legal Business Name | FOSTORIA EYECARE INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 799 N VINE ST FOSTORIA EYECARE INC
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City | FOSTORIA
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State | OH
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Zip | 44830
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Country | US
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Telephone | 419-435-3323
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Fax | 419-435-7834
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Provider Business Mailing Address
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Address Line | 799 N VINE ST
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City | FOSTORIA
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State | OH
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Zip | 44830
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Country | US
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Telephone | 419-435-3323
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Fax | 419-435-7834
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Authorized Official
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Title or Position | OWNER
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Name | DR. FRED W. SKULINA
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Credential | OD
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Telephone | 419-435-3323
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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 | 4314 T655
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License Number State | OH
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