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General NPI Number Information
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NPI Number | 1902981087
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Entity Type | Organization
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Legal Business Name | EYECARE ASSOCIATES OF SOUTHERN OREGON PC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 935 ROYAL AVE
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City | MEDFORD
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State | OR
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Zip | 97504-6140
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Country | US
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Telephone | 541-779-2211
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Fax | 541-779-8778
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Provider Business Mailing Address
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Address Line | 935 ROYAL AVE
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City | MEDFORD
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State | OR
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Zip | 97504-6140
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Country | US
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Telephone | 541-779-2211
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Fax | 541-779-8778
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIAN K MITCHELL
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Credential | O. D.
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Telephone | 541-779-2211
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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 | 3079AT
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License Number State | OR
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