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General NPI Number Information
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NPI Number | 1992967038
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Entity Type | Individual
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Provider Name | BRANDON MONDESIR O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 11794 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32817-4626
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Country | US
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Telephone | 407-904-4431
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Fax | 407-904-4438
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Provider Business Mailing Address
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Address Line | 11794 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32817-4626
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Country | US
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Telephone | 407-904-4431
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Fax | 407-904-4438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 4482
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License Number State | FL
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