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General NPI Number Information
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NPI Number | 1649591082
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Entity Type | Organization
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Legal Business Name | SMOOT EYE CARE, LLC
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 1515 K ST
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City | BEDFORD
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State | IN
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Zip | 47421-3723
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Country | US
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Telephone | 812-675-4199
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Fax | 812-675-0301
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Provider Business Mailing Address
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Address Line | 1515 K ST
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City | BEDFORD
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State | IN
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Zip | 47421-3723
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Country | US
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Telephone | 812-675-4199
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Fax | 812-675-0301
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MICHELLE LYNN SMOOT
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Credential | O.D.
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Telephone | 812-583-9203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 18003555A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003555A
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License Number State | IN
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