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General NPI Number Information
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NPI Number | 1114320041
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Entity Type | Organization
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Legal Business Name | HEALTHKONSCIOUS EYE CARE INC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 10057 SUNSET STRIP STE B
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City | SUNRISE
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State | FL
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Zip | 33322-5301
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Country | US
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Telephone | 954-749-5882
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Fax |
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Provider Business Mailing Address
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Address Line | 7973 NW 70TH AVE
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City | PARKLAND
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State | FL
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Zip | 33067-3972
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Country | US
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Telephone | 954-802-6033
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KAREN M MICHAELINE MALCOLM-GRIFFITH
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Credential | O.D.
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Telephone | 954-802-6033
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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 | OPC4717
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License Number State | FL
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