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Individual
CANDACE ELLIS
Active
Individual
CANDACE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC5295
FL
152W00000X
Optometrist
TA2510
MD
Other
Enumeration date
02/26/2016
Last updated
02/06/2017
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