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General NPI Number Information
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NPI Number | 1912198151
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Entity Type | Individual
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Provider Name | ADIS DIAZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2225 SUN VISTA DR
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City | LUTZ
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State | FL
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Zip | 33559-6861
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Country | US
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Telephone | 813-607-2730
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Fax | 656-223-2000
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Provider Business Mailing Address
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Address Line | PO BOX 207151
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City | DALLAS
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State | TX
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Zip | 75320-7151
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV007172
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5689
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License Number State | FL
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