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General NPI Number Information
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NPI Number | 1518266568
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Entity Type | Organization
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Legal Business Name | EXCEL LASER VISION INSTITUTE
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 16542 VENTURA BLVD 400
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City | ENCINO
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State | CA
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Zip | 91436-2005
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Country | US
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Telephone | 818-907-8606
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Fax | 818-379-9786
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Provider Business Mailing Address
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Address Line | 16542 VENTURA BLVD. SUITE 400
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City | ENCINO
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State | CA
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Zip | 91436-5045
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Country | US
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Telephone | 818-907-8606
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Fax | 818-379-9786
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Authorized Official
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Title or Position | CHIEF SURGEON
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Name | DR. FERZAAD MOOSA
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Credential | M.D.
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Telephone | 818-907-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | A60007
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License Number State | CA
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