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General NPI Number Information
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NPI Number | 1427929876
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Entity Type | Organization
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Legal Business Name | SOUTHPORT EYE CARE OD PLLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1620 N HOWE ST
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City | SOUTHPORT
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State | NC
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Zip | 28461-8904
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Country | US
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Telephone | 919-464-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 118 W 14TH ST UNIT A
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City | SOUTHPORT
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State | NC
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Zip | 28461-0406
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Country | US
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Telephone | 919-464-4050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZACHERY TAYLOR STEPHENSON
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Credential | OD
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Telephone | 919-464-4050
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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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