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General NPI Number Information
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NPI Number | 1972629293
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Entity Type | Organization
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Legal Business Name | EYECARE CENTER OF SALEM, LLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 660 CAPITOL ST NE
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City | SALEM
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State | OR
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Zip | 97301
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Country | US
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Telephone | 503-364-0512
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Fax | 503-588-7108
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Provider Business Mailing Address
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Address Line | 1415 CAPITOL ST NE
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City | SALEM
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State | OR
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Zip | 97301-2504
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Country | US
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Telephone | 503-364-0512
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Fax | 503-588-7108
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DANIEL BISHOP
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Credential | OD
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Telephone | 503-364-0512
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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 | 1472ATI
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License Number State | OR
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