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General NPI Number Information
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NPI Number | 1699267526
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Entity Type | Organization
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Legal Business Name | RICHARDS FAMILY EYECARE LLC
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 1585 ROME HWY
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City | CEDARTOWN
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State | GA
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Zip | 30125-4402
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Country | US
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Telephone | 770-748-7406
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Fax |
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Provider Business Mailing Address
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Address Line | 7147 AVALON DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5626
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Country | US
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Telephone | 404-277-8211
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MICHAEL E. RICHARDS
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Credential | OD
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Telephone | 404-277-8211
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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 | OPT001088
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License Number State | GA
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