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General NPI Number Information
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NPI Number | 1972773349
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Entity Type | Organization
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Legal Business Name | LOW VISION CENTER, INC.
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Dates
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Enumeration Date | 03/02/2008
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 1124 E WEISGARBER RD SUITE 204
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City | KNOXVILLE
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State | TN
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Zip | 37909-2686
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Country | US
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Telephone | 865-522-2449
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Fax | 865-522-6453
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Provider Business Mailing Address
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Address Line | 1124 E WEISGARBER RD SUITE 204
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City | KNOXVILLE
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State | TN
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Zip | 37909-2686
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Country | US
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Telephone | 865-522-2449
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Fax | 865-522-6453
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE D. GILLILAND
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Credential | O.D.
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Telephone | 865-522-2449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 1593OD
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License Number State | TN
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