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General NPI Number Information
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NPI Number | 1811141518
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Entity Type | Organization
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Legal Business Name | EYEVOLUTION, INC.
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 42 S FRANKLIN ST
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City | NYACK
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State | NY
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Zip | 10960-3732
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Country | US
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Telephone | 845-353-4701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 722
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City | NYACK
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State | NY
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Zip | 10960-0722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW JUDE WATSON
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Credential | O.D.
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Telephone | 845-353-4701
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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 |
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License Number State |
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