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General NPI Number Information
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NPI Number | 1912255365
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Entity Type | Organization
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Legal Business Name | EXPRESS VISION CARE, INC.
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 1550 W 84TH ST STE 15
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City | HIALEAH
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State | FL
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Zip | 33014-3368
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Country | US
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Telephone | 786-587-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 W 84TH ST STE 15
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City | HIALEAH
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State | FL
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Zip | 33014-3368
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Country | US
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Telephone | 786-587-7404
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | RAUL LOPEZ
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Credential | LDO
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Telephone | 786-587-7404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DO6361
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License Number State | FL
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