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General NPI Number Information
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NPI Number | 1194031427
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Entity Type | Organization
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Legal Business Name | LARRY SIMPFENDERFER OD INC
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 1210 W TOKAY ST
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City | LODI
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State | CA
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Zip | 95240-3810
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Country | US
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Telephone | 209-334-2626
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Fax | 209-334-0710
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Provider Business Mailing Address
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Address Line | 1210 W TOKAY ST
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City | LODI
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State | CA
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Zip | 95240-3810
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Country | US
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Telephone | 209-334-2626
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Fax | 209-334-0710
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY JAMES SIMPFENDERFER
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Credential | O.D.
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Telephone | 209-334-2626
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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 | OPT7804TPL
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License Number State | CA
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