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General NPI Number Information
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NPI Number | 1972070191
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Entity Type | Individual
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Provider Name | BRYCE RANDAL HEFFINGTON OD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 1350 E WOODHURST DR
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4281
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Country | US
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Telephone | 417-882-3937
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Fax | 417-887-8551
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Provider Business Mailing Address
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Address Line | PO BOX 774
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City | SPRINGFIELD
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State | MO
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Zip | 65801-0774
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Country | US
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Telephone | 417-869-3937
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Fax | 417-869-0281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2018038605
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License Number State | MO
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