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General NPI Number Information
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NPI Number | 1881117109
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Entity Type | Organization
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Legal Business Name | SUMMIT VISION INC.
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 3416 MONCRIEF RD STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32209-4340
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Country | US
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Telephone | 904-861-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 4408 GRAY HERON LN
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City | ORANGE PARK
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State | FL
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Zip | 32065-2660
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Country | US
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Telephone | 904-993-1800
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ALBERT CHESTER II
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Credential | PHARMD.
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Telephone | 904-993-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | FL
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