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General NPI Number Information
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NPI Number | 1922358100
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Entity Type | Organization
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Legal Business Name | WINSLOW RETINA & VISION CENTER, INC.
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 1649 W EAU GALLIE BLVD SUITE 201
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City | MELBOURNE
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State | FL
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Zip | 32935-4160
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Country | US
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Telephone | 321-622-5650
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Fax | 321-622-5645
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Provider Business Mailing Address
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Address Line | 1649 W EAU GALLIE BLVD SUITE 201
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City | MELBOURNE
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State | FL
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Zip | 32935-4160
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Country | US
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Telephone | 321-622-5650
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAUL WINSLOW
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Credential | M.D.
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Telephone | 321-622-5650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME91061
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License Number State | FL
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