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General NPI Number Information
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NPI Number | 1063298222
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Entity Type | Individual
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Provider Name | CAROLYN GISELE CHACON OD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 417 W SPRUCE ST
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City | PERKASIE
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State | PA
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Zip | 18944-1865
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Country | US
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Telephone | 267-810-5909
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Fax |
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Provider Business Mailing Address
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Address Line | 417 W SPRUCE ST
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City | PERKASIE
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State | PA
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Zip | 18944-1865
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Country | US
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Telephone | 267-810-5909
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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 | OEG004066
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License Number State | PA
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