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General NPI Number Information
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NPI Number | 1114935426
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Entity Type | Individual
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Provider Name | JOSEPH K DOUGLAS O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 5025 SHATTUCK RD
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City | SAGINAW
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State | MI
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Zip | 48603
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Country | US
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Telephone | 989-752-7121
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Fax | 989-752-6918
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Provider Business Mailing Address
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Address Line | 5025 SHATTUCK RD
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City | SAGINAW
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State | MI
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Zip | 48603-2823
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Country | US
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Telephone | 989-752-7121
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Fax | 989-752-6918
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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 | 4901004056
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License Number State | MI
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