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General NPI Number Information
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NPI Number | 1104418490
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Entity Type | Individual
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Provider Name | ANGELICA JONES OD
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 778 BEAL PKWY NW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-3042
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Country | US
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Telephone | 850-586-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 4633 HERMOSA RD
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City | CRESTVIEW
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State | FL
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Zip | 32539-6734
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Country | US
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Telephone | 601-818-1428
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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 | OPC5892
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | SE68TAC09
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License Number State | AL
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