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General NPI Number Information
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NPI Number | 1811189731
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Entity Type | Organization
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Legal Business Name | WOOLF EYE CLINIC, LTD
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 2855 E BROWN RD SUITE #10
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City | MESA
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State | AZ
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Zip | 85213-4213
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Country | US
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Telephone | 480-969-1000
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Fax | 480-644-0869
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Provider Business Mailing Address
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Address Line | PO BOX 31447
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City | MESA
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State | AZ
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Zip | 85275-1447
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Country | US
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Telephone | 480-969-1000
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Fax | 480-644-0869
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM A WOOLF
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Credential | M.D.
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Telephone | 480-969-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 12396
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License Number State | AZ
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