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General NPI Number Information
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NPI Number | 1881096048
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Entity Type | Organization
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Legal Business Name | COLASURDO FAMILY EYECARE INC.
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 15302 N NEBRASKA AVE
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City | TAMPA
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State | FL
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Zip | 33613-1448
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Country | US
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Telephone | 813-971-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 14408 TENNYSON DR
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City | HUDSON
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State | FL
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Zip | 34667-8531
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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 | PRESIDENT
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Name | DR. VICTORIA COLASURDO
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Credential | O.D.
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Telephone | 727-534-0710
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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 | 4944
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License Number State | FL
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