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General NPI Number Information
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NPI Number | 1760258552
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Entity Type | Organization
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Legal Business Name | VINEYARD EYE CARE LLC
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 691 E 400 N STE 220
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City | VINEYARD
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State | UT
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Zip | 84059-7510
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Country | US
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Telephone | 801-717-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 691 E 400 N STE 220
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City | VINEYARD
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State | UT
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Zip | 84059-7510
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Country | US
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Telephone | 801-754-6955
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Fax | 801-436-3710
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DAXTON AARON HAWKS
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Credential | OD, MBA
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Telephone | 801-717-5655
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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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