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General NPI Number Information
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NPI Number | 1003605114
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Entity Type | Individual
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Provider Name | BROOKE RADCLIFFE
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Gender | Female
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1945 CEI DR
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City | BLUE ASH
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State | OH
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Zip | 45242-5664
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Country | US
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Telephone | 513-984-5133
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Fax |
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Provider Business Mailing Address
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Address Line | 115 CHATEAU VALLEY LN
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City | SOUTH LEBANON
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State | OH
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Zip | 45065-8749
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Country | US
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Telephone | 513-405-3596
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Fax |
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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 | OPT.007416
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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