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General NPI Number Information
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NPI Number | 1750451449
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EYE CARE ASSOCIATES PA
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 2901 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-2125
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Country | US
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Telephone | 903-831-5706
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Fax | 903-832-4506
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Provider Business Mailing Address
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Address Line | PO BOX 9628
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0028
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Country | US
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Telephone | 903-831-5706
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Fax | 903-832-4450
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT RUSSELL ORGAIN
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Credential | O.D.
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Telephone | 903-831-5706
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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 |
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License Number State |
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