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General NPI Number Information
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NPI Number | 1033235080
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Entity Type | Organization
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Legal Business Name | WYNWOOD EYE CLINIC, INC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 1121 WESTBRANCH HIGHWAY
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City | WINFIELD
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State | AL
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Zip | 17889
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Country | US
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Telephone | 570-523-1533
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 WESTBRANCH HWY
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City | WINFIELD
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State | PA
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Zip | 17889-9253
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Country | US
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Telephone | 570-523-1533
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Fax | 570-523-0040
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MAXWELL CIUMMEI
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Credential |
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Telephone | 570-523-1533
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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 | OEG000171
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License Number State | PA
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