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General NPI Number Information
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NPI Number | 1851825830
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Entity Type | Organization
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Legal Business Name | SUNRISE VISTA LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 3612 AVENUE F
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City | BAY CITY
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State | TX
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Zip | 77414-7604
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Country | US
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Telephone | 979-244-1440
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Fax | 979-244-3122
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Provider Business Mailing Address
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Address Line | PO BOX 4615 MSC 275
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City | HOUSTON
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State | TX
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Zip | 77210-4615
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Country | US
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Telephone | 713-275-2457
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Fax | 713-275-2496
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL M MANN SR.
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Credential | MD
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Telephone | 281-446-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D7443
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License Number State | TX
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