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General NPI Number Information
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NPI Number | 1184686883
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Entity Type | Individual
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Provider Name | SUSAN MITHOFF QUADE OD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 2299 WEST RD
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City | TRENTON
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State | MI
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Zip | 48183-3615
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Country | US
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Telephone | 734-676-4500
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Fax | 734-676-1587
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Provider Business Mailing Address
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Address Line | 2299 WEST RD
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City | TRENTON
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State | MI
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Zip | 48183-3615
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Country | US
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Telephone | 734-676-4500
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Fax | 734-676-1587
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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 | 4901003686
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License Number State | MI
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