| Document Date: 2013-10-03 07:10:26
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City Washington / Mason / New York / Subscriber / / Country Puerto Rico / / Currency USD / / Facility prison Tennessee / / IndustryTerm insurance fraud / insurance policy containing / insurance claimant / state law / organization employer / insurance / insurance application / insurance benefits / insurance proceeds / submitted vision care services / fraudulent insurance act / / Organization Colorado Division of Insurance / / Position optometrist / / ProvinceOrState Texas / Tennessee / Kansas / Kentucky / Nebraska / New Jersey / Vermont / West Virginia / New Mexico / Ohio / Minnesota / Alaska / Maine / District of Columbia / Pennsylvania / Rhode Island / Maryland / Oklahoma / Indiana / Delaware / Louisiana / Oregon / Florida / Hawaii / North Carolina / California / Arizona / Idaho / Colorado / Arkansas / New Hampshire / / Region West Virginia / /
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Administered By First American Administrators Out of Network Vision Services Claim Form State of Delaware – Diabetic/Vision Therapy