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General NPI Number Information
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NPI Number | 1588184550
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Entity Type | Organization
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Legal Business Name | DANIEL MAX & MARC ANDREA LLC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 790 SKYMARKS DR STE 107
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7267
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Country | US
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Telephone | 904-527-2700
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Fax | 561-828-8367
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Provider Business Mailing Address
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Address Line | 1615 S CONGRESS AVE STE 105
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6326
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Country | US
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Telephone | 561-208-8464
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Fax |
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Authorized Official
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Title or Position | MANAGER OF HEALTH SERVICES
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Name | KIRSTEN PIPHER CANTRELL
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Credential |
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Telephone | 561-208-8464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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