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General NPI Number Information
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NPI Number | 1821261801
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Entity Type | Organization
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Legal Business Name | STAMFORD VISION CARE.LLC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 526 NEWFIELD AVE
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City | STAMFORD
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State | CT
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Zip | 06905-3746
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Country | US
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Telephone | 203-327-1511
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Fax | 203-325-4479
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Provider Business Mailing Address
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Address Line | 526 NEWFIELD AVE
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City | STAMFORD
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State | CT
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Zip | 06905-3746
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Country | US
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Telephone | 203-327-1511
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Fax | 203-325-4479
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JOHN P DECARLO
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Credential | O.D.
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Telephone | 203-327-1511
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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 | 704
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2021
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License Number State | CT
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