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General NPI Number Information
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NPI Number | 1972262319
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Entity Type | Organization
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Legal Business Name | NORTHLAKE EYECARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 4800 BRIARCLIFF RD NE STE 1173
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City | ATLANTA
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State | GA
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Zip | 30345-2743
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Country | US
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Telephone | 770-359-7647
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 BRIARCLIFF RD NE STE 1173
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City | ATLANTA
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State | GA
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Zip | 30345-2743
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Country | US
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Telephone | 770-359-7647
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RADHAKRISHNA ISHWARBHAI PATEL
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Credential | OD
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Telephone | 770-359-7647
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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 |
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License Number State |
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