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General NPI Number Information
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NPI Number | 1346050895
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Entity Type | Individual
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Provider Name | BRYAN ALFONSO OD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 8430 MILLS DR
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City | MIAMI
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State | FL
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Zip | 33183-4807
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Country | US
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Telephone | 305-279-4260
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Fax |
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Provider Business Mailing Address
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Address Line | 14748 SW 61ST LN
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City | MIAMI
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State | FL
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Zip | 33193-2403
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Country | US
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Telephone | 786-259-7005
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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 | OPC6595
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License Number State | FL
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