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General NPI Number Information
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NPI Number | 1891097150
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Entity Type | Organization
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Legal Business Name | DESERT VISION AND EYE CARE, LLC
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 4116 W CRAIG RD STE 104
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-2733
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Country | US
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Telephone | 702-631-2015
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Fax | 702-631-2511
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Provider Business Mailing Address
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Address Line | 8724 AZURE SKY DR
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City | LAS VEGAS
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State | NV
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Zip | 89129-2223
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Country | US
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Telephone | 702-631-2015
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Fax | 702-631-2511
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD MAZZULLA
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Credential | O.D.
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Telephone | 702-631-2015
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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 | 0231
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License Number State | NV
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