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General NPI Number Information
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NPI Number | 1013520436
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Entity Type | Organization
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Legal Business Name | VOLUSIA VISION
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 641 MIDDLEBURY LOOP
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-2115
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Country | US
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Telephone | 407-353-9656
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Fax |
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Provider Business Mailing Address
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Address Line | 641 MIDDLEBURY LOOP
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-2115
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Country | US
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Telephone | 407-353-9656
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KAILY M TSCHANTZ
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Credential | OD
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Telephone | 407-353-9656
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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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