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General NPI Number Information
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NPI Number | 1215318654
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Entity Type | Individual
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Provider Name | BRETT-ASHLEY PALMER OD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 619 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-5808
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Country | US
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Telephone | 386-755-3016
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Fax |
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Provider Business Mailing Address
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Address Line | 2524 LANTANA LN
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City | TALLAHASSEE
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State | FL
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Zip | 32311-1661
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Country | US
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Telephone | 561-676-4662
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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 | OPT0003128
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5270
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License Number State | FL
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