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General NPI Number Information
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NPI Number | 1720507999
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Entity Type | Organization
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Legal Business Name | REFRACTIVE SURGERY PROFESSIONALS LLC
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8500 KEYSTONE XING STE 150
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City | INDIANAPOLIS
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State | IN
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Zip | 46240
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Country | US
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Telephone | 317-202-0669
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 KEYSTONE XING STE 150
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-4370
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Country | US
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Telephone | 317-202-0669
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DIANA FISHER
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Credential | OD
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Telephone | 317-202-0669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 18003300
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License Number State | IN
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