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General NPI Number Information
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NPI Number | 1720201452
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Entity Type | Organization
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Legal Business Name | AZ HOME EYE CARE INC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 5620 W THUNDERBIRD RD #H-3
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City | GLENDALE
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State | AZ
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Zip | 85306-4636
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Country | US
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Telephone | 602-424-0866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16996
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City | PHOENIX
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State | AZ
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Zip | 85011-6996
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Country | US
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Telephone | 602-424-0866
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BRIAN ANDREW MACH
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Credential | O.D
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Telephone | 602-424-0866
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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 | 551
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License Number State | AZ
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