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General NPI Number Information
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NPI Number | 1013003532
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Entity Type | Organization
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Legal Business Name | VASCU VISION INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 12794 W. FOREST HILL BLVD. SUITE 30
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City | WELLINGTON
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State | FL
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Zip | 33414-4710
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Country | US
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Telephone | 561-795-6868
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Fax | 561-795-6869
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Provider Business Mailing Address
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Address Line | 12794 W. FOREST HILL BLVD. SUITE 30
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City | WELLINGTON
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State | FL
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Zip | 33414-4710
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Country | US
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Telephone | 561-795-6868
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Fax | 561-795-6869
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARCIA ELAINE ROY
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Credential | RT,RDMS,RVT,RDCS,CCT
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Telephone | 561-795-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC4566
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License Number State | FL
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