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General NPI Number Information
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NPI Number | 1659347698
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Entity Type | Individual
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Provider Name | JEFFREY K. DAVIS OD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 2922 JEFFERSON ST
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City | MARIANNA
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State | FL
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Zip | 32446-3448
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Country | US
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Telephone | 850-526-4550
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Fax | 850-526-1200
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Provider Business Mailing Address
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Address Line | 2922 JEFFERSON ST
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City | MARIANNA
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State | FL
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Zip | 32446-3448
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Country | US
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Telephone | 850-526-4550
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Fax | 850-526-1200
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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 | OPC1631
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License Number State | FL
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