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General NPI Number Information
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NPI Number | 1861633323
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Entity Type | Organization
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Legal Business Name | LUM EYE AND VISION CENTER A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 3088 TELEGRAPH RD SUITE A
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City | VENTURA
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State | CA
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Zip | 93003-3234
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Country | US
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Telephone | 805-648-6891
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Fax | 805-648-6386
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Provider Business Mailing Address
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Address Line | 3088 TELEGRAPH RD SUITE A
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City | VENTURA
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State | CA
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Zip | 93003-3234
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Country | US
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Telephone | 805-648-6891
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Fax | 805-648-6386
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. KEITH ALLEN WINTERMUTE
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Credential | MDIV
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Telephone | 805-648-6891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | CA
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