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General NPI Number Information
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NPI Number | 1700147931
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Entity Type | Organization
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Legal Business Name | MOSS EYE CARE, LLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 2209 FORSYTHE AVE
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City | MONROE
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State | LA
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Zip | 71201-3643
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Country | US
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Telephone | 318-387-5657
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Fax | 318-325-8472
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Provider Business Mailing Address
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Address Line | 2209 FORSYTHE AVE
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City | MONROE
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State | LA
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Zip | 71201-3643
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Country | US
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Telephone | 318-387-5657
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Fax | 318-325-8472
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JOSEPH CARTER MOSS
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Credential | O.D.
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Telephone | 318-387-5657
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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 | 1559-591T
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License Number State | LA
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