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General NPI Number Information
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NPI Number | 1689789570
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Entity Type | Organization
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Legal Business Name | ROSE VISION CARE LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1713 GIBSON ST
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City | WEST PLAINS
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State | MO
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Zip | 65775-1815
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Country | US
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Telephone | 417-256-8393
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Fax |
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Provider Business Mailing Address
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Address Line | 1713 GIBSON ST
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City | WEST PLAINS
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State | MO
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Zip | 65775-1815
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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 | OWNER
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Name | DR. JASON TOD ROSE
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Credential | O.D.
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Telephone | 417-256-8393
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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 | 2001024885
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License Number State | MO
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