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General NPI Number Information
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NPI Number | 1073764106
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Entity Type | Organization
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Legal Business Name | FLORIDA EYE CLINIC AMBULATORY SURGICAL CENTER, INC.
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 975 TOWN CENTER DR SUITE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8269
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Country | US
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Telephone | 407-834-7776
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Fax | 407-834-0973
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Provider Business Mailing Address
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Address Line | 160 BOSTON AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4706
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Country | US
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Telephone | 407-834-7776
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Fax | 407-834-0973
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GEN PARM
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Credential |
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Telephone | 407-834-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 945
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License Number State | FL
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