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General NPI Number Information
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NPI Number | 1861785701
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Entity Type | Organization
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Legal Business Name | DR. MO'S EYE CARE
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 2000 CLEMENTS BRIDGE RD STE 116
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City | DEPTFORD
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State | NJ
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Zip | 08096-2016
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Country | US
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Telephone | 856-384-2501
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Fax | 856-384-2503
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Provider Business Mailing Address
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Address Line | 2433 LAFAYETTE AVE
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City | ROSLYN
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State | PA
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Zip | 19001-4206
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Country | US
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Telephone | 856-577-3471
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Fax | 215-884-0818
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | KELLY MOLOCK-HEROLD
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Credential | O.D
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Telephone | 856-577-3471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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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 |
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License Number State |
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