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General NPI Number Information
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NPI Number | 1982981734
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Entity Type | Organization
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Legal Business Name | JAKSON EYECARE INC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 1900 S UNIVERSITY DR
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City | MIRAMAR
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State | FL
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Zip | 33025-2230
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Country | US
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Telephone | 727-744-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 NE 17TH WAY UNIT 1001
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2458
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Country | US
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Telephone | 727-744-5608
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KINGA JAKSON
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Credential | O.D.
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Telephone | 727-744-5608
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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 | OPC 4455
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License Number State | FL
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