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General NPI Number Information
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NPI Number | 1164539821
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Entity Type | Individual
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Provider Name | THOMAS KENNETH BIALECKE OD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1350 N GALENA AVE
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City | DIXON
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State | IL
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Zip | 61021
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Country | US
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Telephone | 815-284-3935
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Fax | 815-284-6094
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Provider Business Mailing Address
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Address Line | 4 TERRACE DR
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City | OREGON
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State | IL
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Zip | 61061-1237
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Country | US
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Telephone | 815-732-6966
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Fax | 815-732-7613
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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 |
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License Number State | IL
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