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General NPI Number Information
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NPI Number | 1508066333
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Entity Type | Organization
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Legal Business Name | COMERFORD OPTOMETRY INC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 4901 GATE PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4405
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Country | US
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Telephone | 904-564-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 360 ROSCOE BLVD N
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2144
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Country | US
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Telephone | 904-543-0881
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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. MATTHEW COMERFORD
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Credential |
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Telephone | 904-564-9511
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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 | OPC3703
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License Number State | FL
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