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General NPI Number Information
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NPI Number | 1811261969
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Entity Type | Organization
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Legal Business Name | VITRECTOMY RECOVERY EQUIPMENT
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 1509 W WINDY WILLOW DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-5094
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Country | US
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Telephone | 904-230-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 W WINDY WILLOW DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-5094
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Country | US
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Telephone | 904-230-5400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DIANE H. BOX
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Credential |
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Telephone | 904-230-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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