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General NPI Number Information
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NPI Number | 1972293843
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Entity Type | Organization
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Legal Business Name | COHERENT EYE CARE, LLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 161 BERLIN RD
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City | CROMWELL
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State | CT
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Zip | 06416-1059
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Country | US
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Telephone | 860-635-5801
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Fax |
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Provider Business Mailing Address
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Address Line | 47 ROSE HILL RD
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City | PORTLAND
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State | CT
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Zip | 06480-1253
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MARK CALIXTE
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Credential |
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Telephone | 860-881-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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