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General NPI Number Information
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NPI Number | 1659811511
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Entity Type | Organization
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Legal Business Name | EYECARE DOCTOR LLC
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Dates
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Enumeration Date | 02/26/2017
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 1172 GRAYSTONE RD
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City | MANHEIM
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State | PA
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Zip | 17545-8822
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Country | US
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Telephone | 717-917-6363
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Fax | 717-459-3482
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Provider Business Mailing Address
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Address Line | 1465 LANCASTER RD
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City | MANHEIM
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State | PA
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Zip | 17545-9768
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Country | US
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Telephone | 717-879-6900
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Fax | 717-879-6901
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHERYL KAY HUDISH
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Credential | OD
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Telephone | 717-917-6363
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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 | OET008805
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License Number State | PA
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