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General NPI Number Information
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NPI Number | 1033602230
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Entity Type | Individual
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Provider Name | MICAELA RAE GOBEILLE OD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 163 BROADWAY ST
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City | COLCHESTER
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State | CT
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Zip | 06415-1022
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Country | US
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Telephone | 860-537-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 16 LINWOOD RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-5207
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Country | US
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Telephone | 401-714-2574
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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 | 5455
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 3151
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | PENDING
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License Number State | NY
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