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General NPI Number Information
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NPI Number | 1952604290
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CENTER SOUTH LLC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 5125 S. LAKELAND DR SUITE 1
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City | LAKELAND
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State | FL
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Zip | 33813-2578
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Country | US
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Telephone | 863-644-7773
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Fax | 863-646-2809
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Provider Business Mailing Address
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Address Line | 5125 S. LAKELAND DR SUITE 1
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City | LAKELAND
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State | FL
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Zip | 33813-2578
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Country | US
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Telephone | 863-644-7773
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Fax | 863-646-2809
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Authorized Official
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Title or Position | OWNER/ MANAGING MEMBER
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Name | DR. ANTHONY B. TRAWICK
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Credential | O.D.
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Telephone | 863-644-7773
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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 | OPC-1885
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License Number State | FL
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