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General NPI Number Information
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NPI Number | 1689841470
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Entity Type | Organization
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Legal Business Name | MY VISION CARE CORPATION
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 1580 LEMOINE AVE SUITE 5
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City | FORT LEE
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State | NJ
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Zip | 07024-5621
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Country | US
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Telephone | 201-944-9266
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Fax | 201-944-6318
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Provider Business Mailing Address
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Address Line | 1580 LEMOINE AVE SUITE 5
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City | FORT LEE
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State | NJ
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Zip | 07024-5621
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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 | GM
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Name | YONGHO CHUNG
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Credential |
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Telephone | 201-944-9266
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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 | 27OA00516300
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License Number State | NJ
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