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General NPI Number Information
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NPI Number | 1902396179
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Entity Type | Organization
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Legal Business Name | CENTRO VISUAL MATOS
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 191 AVE BETANCES
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City | BAYAMON
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State | PR
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Zip | 00959-5159
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Country | US
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Telephone | 787-787-8555
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Fax |
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Provider Business Mailing Address
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Address Line | CAPE SEA VILLAGE 3 GARDENIA 115
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-379-9070
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Fax |
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Authorized Official
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Title or Position | OPTHOMETRIST
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Name | DR. MYLTHIA P MATOS
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Credential | OD
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Telephone | 787-379-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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