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General NPI Number Information
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NPI Number | 1912097353
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Entity Type | Organization
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Legal Business Name | DAYTONA VISION CENTER INC
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 733 DUNLAWTON AVENUE SUITE 101
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City | PORT ORANGE
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State | FL
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Zip | 32127
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Country | US
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Telephone | 386-252-3619
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Fax | 386-252-4429
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Provider Business Mailing Address
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Address Line | 733 DUNLAWTON AVENUE SUITE 101
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City | PORT ORANGE
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State | FL
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Zip | 32127
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Country | US
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Telephone | 386-252-3619
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Fax | 386-252-4429
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL L HAY
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Credential | OD
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Telephone | 386-252-3619
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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 | OPC#002791
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License Number State | FL
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