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General NPI Number Information
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NPI Number | 1013558139
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Entity Type | Individual
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Provider Name | LETICIA SANTA OD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 949 S GLENDALE ST
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City | WICHITA
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State | KS
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Zip | 67218-3210
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Country | US
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Telephone | 316-685-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 999 N SILVER SPRINGS BLVD APT 907
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City | WICHITA
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State | KS
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Zip | 67212-6036
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Country | US
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Telephone | 413-636-9626
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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 | 3107
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License Number State | CT
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