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General NPI Number Information
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NPI Number | 1295303501
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE PUIG OD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 7800 W 33RD AVE STE 1
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City | HIALEAH
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State | FL
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Zip | 33018-5071
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Country | US
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Telephone | 786-515-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 6711 ORCHID DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2644
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Country | US
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Telephone | 786-973-6416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC5930
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License Number State | FL
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