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General NPI Number Information
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NPI Number | 1972027472
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Entity Type | Organization
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Legal Business Name | ILLINOIS EYE, LLC
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/27/2017
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Provider Practice Location Address
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Address Line | 1630 GATEWAY DR
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City | SYCAMORE
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State | IL
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Zip | 60178-3182
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Country | US
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Telephone | 815-756-8571
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Fax | 815-756-5603
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Provider Business Mailing Address
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Address Line | 2727 N HARWOOD ST STE 250
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City | DALLAS
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State | TX
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Zip | 75201-2410
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Country | US
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Telephone | 844-377-6468
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Fax | 469-677-6260
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. MICHAEL T. FRICKE
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Credential |
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Telephone | 844-377-6468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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