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General NPI Number Information
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NPI Number | 1538127956
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Entity Type | Individual
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Provider Name | DR. MARK WILIIAM PITTALUGA
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 5499 N FEDERAL HWY SUITE E
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City | BOCA RATON
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State | FL
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Zip | 33487-4993
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Country | US
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Telephone | 561-988-0300
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Fax | 561-988-0350
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Provider Business Mailing Address
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Address Line | 5499 N FEDERAL HWY SUITE E
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City | BOCA RATON
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State | FL
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Zip | 33487
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Country | US
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Telephone | 561-988-0300
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Fax | 561-988-0350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC2886
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License Number State | FL
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