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General NPI Number Information
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NPI Number | 1225408628
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Entity Type | Organization
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Legal Business Name | PEREZ VISION CLINIC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 15312 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-3123
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Country | US
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Telephone | 228-831-0515
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Fax | 228-832-1249
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Provider Business Mailing Address
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Address Line | 15312 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-3123
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Country | US
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Telephone | 228-831-0515
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Fax | 228-832-1249
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ASHLEY PEREZ
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Credential |
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Telephone | 228-831-0515
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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 | 485
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License Number State | MS
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