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General NPI Number Information
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NPI Number | 1851476493
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Entity Type | Organization
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Legal Business Name | POST FALLS VISION CLINIC PLLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 2525 E SELTICE WAY
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City | POST FALLS
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State | ID
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Zip | 83854-5089
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Country | US
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Telephone | 208-773-7434
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Fax | 208-777-0836
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Provider Business Mailing Address
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Address Line | 2525 E SELTICE WAY PO BOX 997
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City | POST FALLS
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State | ID
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Zip | 83854-5089
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Country | US
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Telephone | 208-773-7434
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Fax | 208-777-0836
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | ELWIN W. SCHUTT
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Credential | O.D.
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Telephone | 208-773-7434
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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 | ODP-499
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License Number State | ID
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