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General NPI Number Information
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NPI Number | 1578583415
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Entity Type | Organization
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Legal Business Name | PRIMARY VISION CARE 1, LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 1236 CASTLE HILL AVE
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City | BRONX
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State | NY
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Zip | 10462-4805
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Country | US
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Telephone | 718-299-3456
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Fax | 718-299-1040
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Provider Business Mailing Address
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Address Line | PO BOX 1006
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City | BRONX
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State | NY
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Zip | 10473-0961
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Country | US
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Telephone | 718-299-3456
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Fax | 718-299-1040
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Authorized Official
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Title or Position | CEO/DOCTOR
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Name | DR. SHARON LOUISE WILLIAMS
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Credential | OD
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Telephone | 718-299-3456
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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 | TUV005576-1
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License Number State | NY
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