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General NPI Number Information
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NPI Number | 1225241961
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Entity Type | Organization
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Legal Business Name | VISTA EYE CARE, PLC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 560 E CONTINENTAL RD STE 104
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-1825
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Country | US
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Telephone | 520-625-5673
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Fax | 520-625-6259
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Provider Business Mailing Address
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Address Line | 560 E CONTINENTAL RD STE 104
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-1825
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Country | US
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Telephone | 520-625-5673
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Fax | 520-625-6259
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Authorized Official
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Title or Position | OPTOMETRIST/MEMBER
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Name | SAMANTHA LYNN CONTRERAS NOGALES
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Credential | OD
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Telephone | 520-625-5673
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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 | 976
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 37027
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License Number State | AZ
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