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General NPI Number Information
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NPI Number | 1790823300
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Entity Type | Organization
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Legal Business Name | EYE RESTORATION CLINIC
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4606 S GARNETT RD #302
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City | TULSA
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State | OK
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Zip | 74146-5231
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Country | US
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Telephone | 918-664-6544
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Fax | 918-664-0668
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Provider Business Mailing Address
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Address Line | 4606 S GARNETT RD #302
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City | TULSA
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State | OK
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Zip | 74146-5231
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Country | US
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Telephone | 918-664-6544
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Fax | 918-664-0668
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Authorized Official
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Title or Position | OCULARIST
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Name | MS. ELSIE M. JOY
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Credential | B.C.O.
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Telephone | 918-664-6544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | NON REQUIRED
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License Number State | OK
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