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General NPI Number Information
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NPI Number | 1649798612
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Entity Type | Organization
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Legal Business Name | BOAN OPTOMETRY INC.
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 08/30/2017
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Provider Practice Location Address
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Address Line | 8942 GARDEN GROVE BLVD. STE 104
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City | GARDEN GROVE
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State | CA
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Zip | 92844
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Country | US
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Telephone | 714-638-0852
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Fax |
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Provider Business Mailing Address
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Address Line | 8942 GARDEN GROVE BLVD STE 104
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City | GARDEN GROVE
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State | CA
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Zip | 92844-3332
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KATHERINE CHUNG
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Credential |
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Telephone | 714-638-0852
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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 | 13978TLG
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License Number State | CA
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