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General NPI Number Information
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NPI Number | 1205843968
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Entity Type | Individual
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Provider Name | JEFF CYTRON O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 961 N MARKET ST
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City | WATERLOO
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State | IL
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Zip | 62298-1005
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Country | US
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Telephone | 618-939-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 REMINGTON LN
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City | SAINT LOUIS
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State | MO
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Zip | 63144-2134
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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 | 046008813
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License Number State | IL
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