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General NPI Number Information
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NPI Number | 1902947690
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Entity Type | Organization
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Legal Business Name | MICHAEL HOLIFIELD OD PA
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 9711 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2309
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Country | US
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Telephone | 954-474-1374
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Fax |
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Provider Business Mailing Address
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Address Line | 9711 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2309
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Country | US
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Telephone | 954-474-1374
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST PRESIDENT
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Name | DR. MICHAEL HOLIFIELD
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Credential | O.D.
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Telephone | 954-474-1374
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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 | FL 3238
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License Number State | FL
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