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General NPI Number Information
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NPI Number | 1184626822
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Entity Type | Individual
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Provider Name | WAYNE A FOWLER O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9 CENTRAL ST
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City | LOWELL
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State | MA
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Zip | 01852-1927
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Country | US
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Telephone | 978-458-4546
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Fax | 978-934-9264
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Provider Business Mailing Address
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Address Line | 22 ROCKY HILL RD
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City | ANDOVER
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State | MA
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Zip | 01810-6118
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Country | US
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Telephone | 978-623-8195
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Fax | 978-934-9264
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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 | 4051
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License Number State | MA
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