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General NPI Number Information
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NPI Number | 1386832244
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Entity Type | Organization
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Legal Business Name | WEST BROWARD EYECARE ASSOCIATES INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 7822 N UNIVERSITY DR
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City | TAMARAC
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State | FL
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Zip | 33321-2114
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Country | US
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Telephone | 954-726-0204
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Fax | 954-721-1578
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Provider Business Mailing Address
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Address Line | 7822 N UNIVERSITY DR
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City | TAMARAC
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State | FL
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Zip | 33321-2114
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Country | US
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Telephone | 954-726-0204
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Fax | 954-721-1578
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GUSTAVO GARMIZO
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Credential | OD
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Telephone | 954-726-0204
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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 | 0001743
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License Number State | FL
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