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General NPI Number Information
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NPI Number | 1134372600
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Entity Type | Organization
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Legal Business Name | ELLISON EYECARE LTD. CO
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 1039 HARLEY STRICKLAND BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-7979
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Country | US
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Telephone | 386-774-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 5545 MISTY WOOD CT
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City | OVIEDO
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State | FL
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Zip | 32765-6612
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. DONALD F. ELLISON
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Credential | O.D.
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Telephone | 407-971-9518
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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 | OPC4124
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License Number State | FL
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