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General NPI Number Information
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NPI Number | 1215005384
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Entity Type | Individual
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Provider Name | MELINDA MARIE WOLTER O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 791 HARTFORD PIKE
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City | DAYVILLE
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State | CT
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Zip | 06241-1715
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Country | US
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Telephone | 860-779-6123
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Fax | 860-779-8655
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Provider Business Mailing Address
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Address Line | 75 HOCKANUM BLVD SUITE #933
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City | VERNON
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State | CT
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Zip | 06066-4056
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Country | US
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Telephone | 860-871-2510
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Fax | 860-871-2510
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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 | 002646
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License Number State | CT
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