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General NPI Number Information
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NPI Number | 1801973110
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Entity Type | Organization
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Legal Business Name | HIGH DESERT EYECARE
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 443 SW EVERGREEN AVE
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City | REDMOND
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State | OR
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Zip | 97756-2817
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Country | US
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Telephone | 541-923-2221
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Fax | 541-923-3776
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Provider Business Mailing Address
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Address Line | PO BOX 918
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City | REDMOND
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State | OR
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Zip | 97756-0206
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Country | US
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Telephone | 541-923-2221
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Fax | 541-923-3776
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ALISHIA DAWN HOLLAND
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Credential | CPOA, CPOC, VSR
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Telephone | 541-923-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2601AT
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License Number State | OR
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