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General NPI Number Information
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NPI Number | 1669559761
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Entity Type | Organization
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Legal Business Name | EYE PHYSICIANS INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 333 MALL RD
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City | LOGANSPORT
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State | IN
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Zip | 46947-2279
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Country | US
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Telephone | 574-722-1797
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Fax | 574-735-2827
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Provider Business Mailing Address
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Address Line | 3433 S LAFOUNTAIN ST
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City | KOKOMO
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State | IN
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Zip | 46902-3801
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Country | US
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Telephone | 765-453-3777
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Fax | 765-453-6577
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL R WILD
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Credential | MD
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Telephone | 765-453-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 50000605A
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License Number State | IN
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