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General NPI Number Information
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NPI Number | 1912411497
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Entity Type | Organization
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Legal Business Name | EYEDOCS FAMILY EYE CARE
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 430 ARLINGTON RD STE A
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City | BROOKVILLE
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State | OH
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Zip | 45309-1103
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Country | US
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Telephone | 513-265-9422
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Fax |
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Provider Business Mailing Address
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Address Line | 430 ARLINGTON RD STE A
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City | BROOKVILLE
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State | OH
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Zip | 45309-1103
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Country | US
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Telephone | 937-770-1265
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Fax | 937-770-1268
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KYLE MAXAM
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Credential | OD
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Telephone | 513-265-9422
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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 | 6478
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License Number State | OH
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