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General NPI Number Information
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NPI Number | 1639302821
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Entity Type | Organization
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Legal Business Name | NELSON EYECARE GROUP, LLC
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 3333 N US HIGHWAY 75
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City | SHERMAN
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State | TX
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Zip | 75090-2525
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Country | US
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Telephone | 903-487-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 MEMORIAL LN APT. 4307
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City | PLANO
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State | TX
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Zip | 75024-2285
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Country | US
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Telephone | 501-779-5728
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MARK E NELSON
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Credential | O.D.
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Telephone | 903-487-0550
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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 | 7389T
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License Number State | TX
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