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General NPI Number Information
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NPI Number | 1093181455
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Entity Type | Organization
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Legal Business Name | DESTINY EYE CARE, PC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 6631 ROSWELL RD STE G
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-3179
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Country | US
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Telephone | 404-843-8248
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Fax |
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Provider Business Mailing Address
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Address Line | 600 GARSON DR NE APT 10307
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City | ATLANTA
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State | GA
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Zip | 30324-6215
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Country | US
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Telephone | 678-770-9941
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Fax | 404-228-9785
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Authorized Official
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Title or Position | OWNER
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Name | DR. DESARAE BONDS
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Credential | O.D.
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Telephone | 678-770-9941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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