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General NPI Number Information
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NPI Number | 1639910649
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Entity Type | Individual
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Provider Name | AUSTIN TAYLOR OD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 1100 S PONCE DE LEON BLVD STE 4
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-6013
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Country | US
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Telephone | 904-824-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 103 BELL ST
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City | HAZLEHURST
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State | GA
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Zip | 31539-6411
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Country | US
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Telephone |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6526
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License Number State | FL
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