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General NPI Number Information
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NPI Number | 1326183252
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Entity Type | Organization
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Legal Business Name | ULTRA VISION OPTICAL CENTER INC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 812 HICKSVILLE RD
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City | N MASSAPEQUA
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State | NY
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Zip | 11758-1262
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Country | US
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Telephone | 516-796-2020
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Fax | 516-796-3818
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Provider Business Mailing Address
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Address Line | 812 HICKSVILLE RD
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City | N MASSAPEQUA
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State | NY
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Zip | 11758-1262
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Country | US
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Telephone | 516-796-2020
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Fax | 516-796-3818
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JASON BART
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Credential | OD
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Telephone | 516-796-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | TUV006342
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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