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General NPI Number Information
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NPI Number | 1720025711
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Entity Type | Individual
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Provider Name | DOMINIC JAMES PASTORE O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 1000 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32935-8937
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Country | US
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Telephone | 321-259-1699
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Fax | 321-259-4658
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Provider Business Mailing Address
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Address Line | PO BOX 560580
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City | ROCKLEDGE
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State | FL
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Zip | 32956-0580
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Country | US
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Telephone | 321-693-1534
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Fax | 321-259-4658
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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 | OPC 3723
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License Number State | FL
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