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General NPI Number Information
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NPI Number | 1619423845
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Entity Type | Organization
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Legal Business Name | GULFSTREAM EYE PLLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 555 NW LAKE WHITNEY PL STE 105
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-1623
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Country | US
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Telephone | 772-448-4865
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Fax | 772-448-4864
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Provider Business Mailing Address
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Address Line | 555 NW LAKE WHITNEY PL STE 105
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-1623
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Country | US
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Telephone | 772-448-4865
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Fax | 772-448-4864
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM ROB VICKERS
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Credential | M.D.
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Telephone | 941-870-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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