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General NPI Number Information
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NPI Number | 1417753427
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Entity Type | Organization
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Legal Business Name | WELLS EYE CARE, P.A.
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 10490 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6207
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Country | US
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Telephone | 904-292-2505
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Fax | 904-262-1113
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Provider Business Mailing Address
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Address Line | 3641 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-9023
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Country | US
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Telephone | 662-587-7852
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY KYLE WELLS
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Credential | OD
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Telephone | 662-587-7852
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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 |
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License Number State |
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