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General NPI Number Information
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NPI Number | 1780622357
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Entity Type | Individual
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Provider Name | RANDELL R RAY OD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 1616 W HENDERSON ST
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City | CLEBURNE
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State | TX
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Zip | 76033-4123
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Country | US
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Telephone | 817-526-5558
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Fax | 817-526-5825
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Provider Business Mailing Address
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Address Line | 8924 SOUTHTHORN DR
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City | N RICHLAND HILLS
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State | TX
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Zip | 76182-7539
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Country | US
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Telephone | 817-526-5558
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Fax | 817-526-5825
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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 | 2873TG
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License Number State | TX
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