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General NPI Number Information
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NPI Number | 1255125654
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Entity Type | Individual
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Provider Name | DEVON SIEVERS
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Gender | Male
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 2011 CORONA RD STE 201
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City | COLUMBIA
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State | MO
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Zip | 65203-2548
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Country | US
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Telephone | 573-447-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E 4TH ST STE 440
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City | ALTON
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State | IL
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Zip | 62002-6206
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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 | 2025023963
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License Number State | MO
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