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General NPI Number Information
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NPI Number | 1184863557
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Entity Type | Organization
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Legal Business Name | DESERT VISION AND EYE CARE
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 4116 W CRAIG RD STE 104
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City | N LAS VEGAS
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State | NV
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Zip | 89032-2732
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Country | US
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Telephone | 702-631-2015
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Fax | 702-631-2511
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Provider Business Mailing Address
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Address Line | 4116 W CRAIG RD STE 104
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City | N LAS VEGAS
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State | NV
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Zip | 89032-2732
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Country | US
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Telephone | 702-631-2015
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Fax | 702-631-2511
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Authorized Official
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Title or Position | PHYSICIAN/PARTNER
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Name | DR. DONALD S. MAZZULLA
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Credential | O.D.
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Telephone | 702-631-2015
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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 | 231
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License Number State | NV
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