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General NPI Number Information
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NPI Number | 1083768261
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Entity Type | Individual
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Provider Name | TRINA RENA WARDEN OD
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 1256 CAMPBELL LN SUITE 106
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City | BOWLING GREEN
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State | KY
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Zip | 42104-1082
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Country | US
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Telephone | 270-796-6021
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Fax | 270-796-6072
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Provider Business Mailing Address
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Address Line | 1945 SCOTTSVILLE RD STE B2 PMB 239
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5836
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Country | US
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Telephone | 270-796-6021
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Fax | 270-796-6072
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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 | 1396DT
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License Number State | KY
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