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General NPI Number Information
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NPI Number | 1770380800
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Entity Type | Organization
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Legal Business Name | MODARES VISION CARE
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 5372 W 16TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-2165
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Country | US
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Telephone | 305-362-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 418 EUCLID AVE
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City | MIAMI BEACH
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State | FL
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Zip | 33139-6525
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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 | OWNER
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Name | MAHSA MODARES
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Credential | OD
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Telephone | 954-560-6983
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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 |
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License Number State |
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