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General NPI Number Information
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NPI Number | 1043704794
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Entity Type | Individual
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Provider Name | TIFFANY NICOLE GRAHAM O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2018
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 566 TOLL GATE RD
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City | WARWICK
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State | RI
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Zip | 02886-2799
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Country | US
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Telephone | 401-738-4800
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Fax | 508-823-0425
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Provider Business Mailing Address
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Address Line | 2401 SUMMIT DR
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City | BRIDGEWATER
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State | MA
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Zip | 02324-2183
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Country | US
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Telephone | 774-506-2857
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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 | 5309
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODTG00662
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License Number State | RI
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