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General NPI Number Information
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NPI Number | 1710179056
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Entity Type | Organization
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Legal Business Name | JASON BATES OD PC
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1600 NORTH RIVERSIDE AVENUE SUITE 2027
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City | MEDFORD
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State | OR
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Zip | 97501
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Country | US
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Telephone | 541-779-9851
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 NORTH RIVERSIDE AVENUE SUITE 2027
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City | MEDFORD
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State | OR
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Zip | 97501
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Country | US
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Telephone | 541-779-9851
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KATHLEEN L MILLER
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Credential | CCMA-A
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Telephone | 541-779-9851
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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 | 3136AT
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License Number State | OR
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