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General NPI Number Information
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NPI Number | 1003241019
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Entity Type | Organization
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Legal Business Name | NORTHEAST FLORIDA EYE CARE ADDOCIATES
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 4413 TOWN CENTER PKWY SUITE 207
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8568
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Country | US
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Telephone | 904-998-9822
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Fax |
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Provider Business Mailing Address
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Address Line | 11406 SAN JOSE BLVD SUITE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7963
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Country | US
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Telephone | 904-260-3839
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Fax |
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Authorized Official
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Title or Position | COO
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Name | RYAN WILLIAMS
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Credential |
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Telephone | 904-545-4465
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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 |
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License Number State |
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