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General NPI Number Information
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NPI Number | 1710007679
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Entity Type | Organization
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Legal Business Name | NORTHEAST FAMILY EYE CARE LTD
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Dates
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Enumeration Date | 04/01/2007
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 10661 LOVELAND MADEIRA RD
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City | LOVELAND
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State | OH
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Zip | 45140-8965
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Country | US
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Telephone | 513-683-8900
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Fax | 513-683-8910
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Provider Business Mailing Address
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Address Line | 10661 LOVELAND MADEIRA RD
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City | LOVELAND
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State | OH
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Zip | 45140-8965
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Country | US
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Telephone | 513-683-8900
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Fax | 513-683-8910
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Authorized Official
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Title or Position | MEMBER
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Name | DR. PAMELA BERNARD
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Credential | OD
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Telephone | 513-683-8900
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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 | 4584
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License Number State | OH
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