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General NPI Number Information
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NPI Number | 1760964795
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Entity Type | Organization
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Legal Business Name | FOCUS EYE CARE PROF LLC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 16 W DIVIDE STREET
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City | BOWMAN
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State | ND
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Zip | 58623
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Country | US
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Telephone | 605-523-7707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 229
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City | BOWMAN
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State | ND
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Zip | 58623-0229
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Country | US
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Telephone | 605-523-7707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARAH STUCHL
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Credential | OD
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Telephone | 701-523-7707
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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 | 739
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License Number State | ND
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