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General NPI Number Information
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NPI Number | 1932861515
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Entity Type | Organization
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Legal Business Name | GULFPORT PRECISION VISION INC
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 450 E PASS RD STE 9
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City | GULFPORT
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State | MS
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Zip | 39507-3212
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Country | US
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Telephone | 228-896-8619
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Fax |
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Provider Business Mailing Address
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Address Line | 450 E PASS RD STE 9
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City | GULFPORT
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State | MS
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Zip | 39507-3212
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Country | US
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Telephone | 228-896-8619
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. MANDI ELKINS SMITH
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Credential | OD
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Telephone | 601-757-5146
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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 |
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License Number State |
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