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General NPI Number Information
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NPI Number | 1033733720
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Entity Type | Individual
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Provider Name | PAUL DESANTIS OD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 1850 SW GATLIN BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2703
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Country | US
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Telephone | 772-336-9281
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Fax |
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Provider Business Mailing Address
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Address Line | 7835 SADDLEBROOK DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC-5767
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License Number State | FL
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