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General NPI Number Information
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NPI Number | 1194342113
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Entity Type | Individual
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Provider Name | MCKENZIE ELIZABETH SYMONS OD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 1202 TROY SCHENECTADY RD
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City | LATHAM
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State | NY
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Zip | 12110-1096
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Country | US
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Telephone | 518-374-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 85 LAUREL LN
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City | QUEENSBURY
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State | NY
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Zip | 12804-8023
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Country | US
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Telephone | 518-795-0818
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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 | 009142-01
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License Number State | NY
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