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General NPI Number Information
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NPI Number | 1770619660
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Entity Type | Individual
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Provider Name | JEFF LEROY LOOKHART O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2086 INDEPENDENCE CENTER DR
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City | INDEPENDENCE
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State | MO
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Zip | 64057
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Country | US
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Telephone | 816-795-7774
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Fax | 816-795-9422
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Provider Business Mailing Address
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Address Line | 9504 TIMBER MEADOW DR
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City | LEES SUMMIT
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State | MO
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Zip | 64086-9502
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Country | US
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Telephone | 816-347-9347
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Fax | 816-795-9422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2001001861
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License Number State | MO
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