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General NPI Number Information
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NPI Number | 1881839405
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Entity Type | Organization
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Legal Business Name | EYE GALLERY INC
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 380 HUKU LII PL SUITE 107
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City | KIHEI
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State | HI
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Zip | 96753-7043
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Country | US
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Telephone | 808-875-4466
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Fax | 808-874-3899
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Provider Business Mailing Address
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Address Line | 380 HUKU LII PL SUITE 107
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City | KIHEI
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State | HI
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Zip | 96753-7043
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Country | US
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Telephone | 808-875-4466
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Fax | 808-874-3899
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ALICIA VAN
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Credential | O.D.
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Telephone | 808-875-4466
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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 | 644
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License Number State | HI
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