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General NPI Number Information
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NPI Number | 1609763135
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Entity Type | Individual
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Provider Name | VENESSA MAE MACHAC OD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 816 LAKE AIR DR
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City | WACO
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State | TX
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Zip | 76710-5745
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Country | US
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Telephone | 254-752-0471
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Fax |
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Provider Business Mailing Address
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Address Line | 128 WOODED CREST DR
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City | WOODWAY
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State | TX
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Zip | 76712-3261
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Country | US
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Telephone | 254-548-3527
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Fax |
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 11450TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11450TG
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License Number State | TX
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