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General NPI Number Information
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NPI Number | 1649763525
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Entity Type | Organization
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Legal Business Name | STPETER EYE CARE, LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 517 AVALON AVE
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City | MUSCLE SHOALS
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State | AL
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Zip | 35661-2811
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Country | US
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Telephone | 256-381-7969
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Fax | 256-381-2747
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Provider Business Mailing Address
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Address Line | 215 POINTE VERDE CIR
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City | MADISON
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State | AL
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Zip | 35758-3615
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Country | US
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Telephone | 256-509-1872
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ST. PETER
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Credential | OD
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Telephone | 256-509-1872
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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 | S-C51-TA-902
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License Number State | AL
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