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General NPI Number Information
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NPI Number | 1770742686
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Entity Type | Organization
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Legal Business Name | AUSTIN VISION CARE, P.A.
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 571 W MARTIN LUTHER KING BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6404
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Country | US
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Telephone | 479-527-0100
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Fax | 479-527-0102
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Provider Business Mailing Address
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Address Line | 571 W MARTIN LUTHER KING BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6404
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Country | US
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Telephone | 479-527-0100
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Fax | 479-527-0102
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Authorized Official
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Title or Position | OWNER
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Name | LAURA ALYCE AUSTIN
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Credential |
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Telephone | 479-527-0100
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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 | 2572
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License Number State | AR
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