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General NPI Number Information
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NPI Number | 1992995112
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Entity Type | Organization
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Legal Business Name | PANORAMA VISION CARE, INC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 221B NE 104TH AVE SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98664-4505
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Country | US
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Telephone | 360-885-9800
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Fax | 360-885-7989
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Provider Business Mailing Address
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Address Line | 519 NW WILDWOOD DR
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City | VANCOUVER
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State | WA
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Zip | 98665-7545
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Country | US
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Telephone | 360-885-9800
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Fax | 360-885-7989
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Authorized Official
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Title or Position | OWNER / OPTOMETRIST
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Name | DR. CLYDE B. SLAVIN
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Credential | OD
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Telephone | 360-885-9800
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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 | OD00001020
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License Number State | WA
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