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General NPI Number Information
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NPI Number | 1679638928
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Entity Type | Individual
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Provider Name | VIC I GIACALONE O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1815 HAWTHORNE BLVD STE 236
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3424
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Country | US
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Telephone | 310-370-1618
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Fax | 310-371-3126
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Provider Business Mailing Address
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Address Line | 1150 W CAPITOL DR #107
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City | SAN PEDRO
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State | CA
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Zip | 90732-5015
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Country | US
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Telephone | 510-514-8435
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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 | 12143T
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License Number State | CA
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