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General NPI Number Information
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NPI Number | 1972641454
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Entity Type | Organization
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Legal Business Name | KNIGHT VISION
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10315 SILVERDALE WAY NW SPACE J1
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City | SILVERDALE
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State | WA
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Zip | 98383-7670
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Country | US
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Telephone | 360-698-7618
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Fax | 360-698-4145
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Provider Business Mailing Address
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Address Line | PO BOX 609
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City | SEABECK
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State | WA
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Zip | 98380-0609
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Country | US
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Telephone | 360-698-7618
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Fax | 360-698-4145
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. TRACY J KNIGHT
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Credential | O.D.
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Telephone | 360-698-7618
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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 | 1552
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License Number State | WA
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