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General NPI Number Information
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NPI Number | 1760657837
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Entity Type | Organization
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Legal Business Name | KELLY EYE CARE, L.L.C.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 7020 YOUREE DR STE A
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City | SHREVEPORT
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State | LA
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Zip | 71105-5109
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Country | US
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Telephone | 318-797-6155
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Fax | 318-797-6102
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Provider Business Mailing Address
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Address Line | 7020 YOUREE DR STE A
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City | SHREVEPORT
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State | LA
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Zip | 71105-5109
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Country | US
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Telephone | 318-797-6155
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Fax | 318-797-6102
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JANICE S. WILLIAMS
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Credential |
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Telephone | 318-797-6155
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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 | 1343-477T
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License Number State | LA
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