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General NPI Number Information
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NPI Number | 1740458553
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Entity Type | Organization
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Legal Business Name | GRANT FAMILY EYE CARE, P.C.
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 5447 MAIN ST
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City | GRANT
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State | AL
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Zip | 35747-8322
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Country | US
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Telephone | 256-728-3937
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Fax | 256-728-3938
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Provider Business Mailing Address
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Address Line | 5447 MAIN ST
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City | GRANT
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State | AL
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Zip | 35747-8322
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Country | US
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Telephone | 256-728-3937
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Fax | 256-728-3938
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORRAINE D. SUMMERLIN
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Credential | O.D.
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Telephone | 256-631-7755
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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 | S969TA526
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License Number State | AL
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