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General NPI Number Information
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NPI Number | 1881754273
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Entity Type | Organization
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Legal Business Name | CAPITAL RETINA ASSOCIATES, PLLC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 7D JOHNSON RD
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City | LATHAM
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State | NY
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Zip | 12110-3003
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Country | US
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Telephone | 518-785-1100
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Fax | 518-785-1109
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Provider Business Mailing Address
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Address Line | 1399 NEW SCOTLAND ROAD PO BOX 129
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City | SLINGERLANDS
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State | NY
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Zip | 12159-0129
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Country | US
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Telephone | 518-785-1100
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Fax | 518-785-1109
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | CHARLES D MAYRON
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Credential | MD, FACS
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Telephone | 518-785-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 171638
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License Number State | NY
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