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General NPI Number Information
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NPI Number | 1922155159
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Entity Type | Organization
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Legal Business Name | SAN DIEGO VISION CARE, INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3560 FAIRMOUNT AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-3420
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Country | US
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Telephone | 619-508-5678
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9545
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City | SAN DIEGO
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State | CA
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Zip | 92169-0545
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Country | US
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Telephone | 858-504-2020
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. SHEIVA POUSTI
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Credential | O.D.
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Telephone | 858-504-2020
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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 | 10403T
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License Number State | CA
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