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Individual
MODESTO MACOGAY BALA III
Active
Individual
MODESTO MACOGAY BALA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9803
TX
152W00000X
Optometrist
OD-901
HI
Other
Enumeration date
02/20/2019
Last updated
04/25/2022
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