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General NPI Number Information
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NPI Number | 1053570846
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Entity Type | Organization
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Legal Business Name | PAUL VISION CARE LLC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 13227 CITY SQUARE DR WALMART VISION CENTER
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7218
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Country | US
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Telephone | 904-696-1433
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Fax |
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Provider Business Mailing Address
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Address Line | 85161 SHINNECOCK HILLS DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-8177
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Country | US
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Telephone | 904-548-0058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADELE DEBRA PAUL
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Credential | O.D.
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Telephone | 305-297-1412
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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 | OPC2093
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License Number State | FL
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