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General NPI Number Information
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NPI Number | 1174618060
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Entity Type | Individual
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Provider Name | MARK V RICCIUTTI OD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 1019 GERMANTOWN PIKE
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462
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Country | US
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Telephone | 610-279-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 GERMANTOWN PIKE
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462
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Country | US
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Telephone |
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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 | OE006805T
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License Number State | PA
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