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General NPI Number Information
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NPI Number | 1043799844
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Entity Type | Individual
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Provider Name | ROBERT D. SULLIVAN OD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 2185 SOUTH MASON RD
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City | TOWN & COUNTRY
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State | MO
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Zip | 63131-1640
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Country | US
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Telephone | 314-821-5666
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Fax | 314-821-5322
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Provider Business Mailing Address
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Address Line | 4801 S CLIFF AVE STE 100
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6954
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Country | US
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Telephone | 816-478-1230
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Fax | 816-350-4585
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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 | 2018021513
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License Number State | MO
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