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General NPI Number Information
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NPI Number | 1609063478
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Entity Type | Organization
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Legal Business Name | SUN COAST EYE CARE INC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 2451 MCMULLEN BOOTH RD SUITE 221
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City | CLEARWATER
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State | FL
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Zip | 33759
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Country | US
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Telephone | 727-216-6214
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Fax | 727-431-0363
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Provider Business Mailing Address
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Address Line | 2451 MCMULLEN BOOTH RD SUITE 221
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City | CLEARWATER
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State | FL
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Zip | 33759
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Country | US
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Telephone | 727-216-6214
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Fax | 727-431-0363
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Authorized Official
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Title or Position | SECRETARY TREASURER
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Name | DR. MARY LOU SMITH
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Credential | B.S., O.D.
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Telephone | 727-216-6214
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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 | OPC2660
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License Number State | FL
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