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General NPI Number Information
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NPI Number | 1699321737
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Entity Type | Organization
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Legal Business Name | BLUEGRASS VISION GROUP OF MOREHEAD PLLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 322 KROGER CTR
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City | MOREHEAD
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State | KY
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Zip | 40351-8895
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Country | US
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Telephone | 859-498-4800
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Fax | 859-498-2021
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Provider Business Mailing Address
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Address Line | 25 STERLING WAY STE C
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City | MT STERLING
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State | KY
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Zip | 40353-1174
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Country | US
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Telephone | 606-727-2800
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Fax | 606-727-2801
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN COLEMAN
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Credential | OD
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Telephone | 606-727-2800
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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 |
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License Number State |
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