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General NPI Number Information
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NPI Number | 1104051630
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Entity Type | Individual
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Provider Name | JEFFREY MICHAEL COHEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 14006 RIVERSIDE DR STE 274
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-1963
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Country | US
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Telephone | 818-461-0595
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Fax | 818-461-0596
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Provider Business Mailing Address
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Address Line | 1555 SIMI TOWN CENTER WAY STE 575
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City | SIMI VALLEY
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State | CA
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Zip | 93065-0535
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Country | US
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Telephone | 818-461-0595
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Fax | 818-461-0596
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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 | OPC 4435
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License Number State | FL
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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 | 14338
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License Number State | CA
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