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General NPI Number Information
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NPI Number | 1144373473
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Entity Type | Organization
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Legal Business Name | COCCIA VISION CARE
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 100 MCCORD ROAD
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City | PONTOTOC
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State | MS
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Zip | 38863
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Country | US
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Telephone | 662-488-9021
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Fax | 662-488-9022
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Provider Business Mailing Address
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Address Line | 103 SCENIC CV
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City | SALTILLO
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State | MS
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Zip | 38866-7950
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Country | US
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Telephone | 662-648-9285
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS RYAN COCCIA
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Credential | O.D.
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Telephone | 662-488-9021
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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 | 739
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License Number State | MS
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