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General NPI Number Information
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NPI Number | 1033283288
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Entity Type | Organization
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Legal Business Name | VISION SOURCE MAITLAND, LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1020 LOCKWOOD BLVD
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City | OVIEDO
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State | FL
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Zip | 32765-6027
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Country | US
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Telephone | 407-971-1001
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Fax | 407-971-1002
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Provider Business Mailing Address
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Address Line | 1020 LOCKWOOD BLVD
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City | OVIEDO
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State | FL
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Zip | 32765-6027
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Country | US
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Telephone | 407-971-1001
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Fax | 407-971-1002
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Authorized Official
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Title or Position | CEO
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Name | DAVID N FISHER
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Credential | OD
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Telephone | 407-971-1001
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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 | OPC003166
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License Number State | FL
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