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General NPI Number Information
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NPI Number | 1649600453
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Entity Type | Organization
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Legal Business Name | OM EYECARE, INC.
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 1290 US HIGHWAY 22 E
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City | NORTH PLAINFIELD
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State | NJ
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Zip | 07060-3518
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Country | US
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Telephone | 908-546-5681
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Fax | 908-546-5682
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Provider Business Mailing Address
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Address Line | 208 LENOX AVE # 103
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City | WESTFIELD
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State | NJ
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Zip | 07090-5120
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Country | US
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Telephone | 908-315-7907
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Fax | 908-546-5682
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Authorized Official
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Title or Position | OD/PRESIDENT
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Name | MILI SHUKLA
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Credential | OD
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Telephone | 908-546-5681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 27OA00601300
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License Number State | NJ
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