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General NPI Number Information
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NPI Number | 1245721232
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Entity Type | Individual
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Provider Name | EMILY N SELF OD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 703 W COSHOCTON ST
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City | JOHNSTOWN
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State | OH
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Zip | 43031-9581
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Country | US
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Telephone | 937-243-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 5061 EDERTON PL
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City | NEW ALBANY
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State | OH
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Zip | 43054-9460
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Country | US
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Telephone | 937-243-7720
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Fax | 740-817-9202
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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 | OPT.006659
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License Number State | OH
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