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General NPI Number Information
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NPI Number | 1952786345
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Entity Type | Organization
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Legal Business Name | POOLE FAMILY EYE CARE OF SPARTANBURG LLC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 705 E MAIN ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1281
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Country | US
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Telephone | 864-585-3281
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Fax | 864-858-2255
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Provider Business Mailing Address
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Address Line | PO BOX 80927
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-0016
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Country | US
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Telephone | 864-436-1234
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Fax | 864-963-7319
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. BRIAN J POOLE
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Credential | D.O.
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Telephone | 864-680-3037
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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 | 1791
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License Number State | SC
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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 | 1731
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 539
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1414
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License Number State | SC
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