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General NPI Number Information
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NPI Number | 1295266583
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Entity Type | Individual
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Provider Name | CATHLEEN ROSALIE CARABALLO SHANKS O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 2190 9TH ST N
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City | NAPLES
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State | FL
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Zip | 34102-4819
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Country | US
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Telephone | 239-263-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 15493 SUMMIT PLACE CIR
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City | NAPLES
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State | FL
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Zip | 34119-4123
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Country | US
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Telephone | 813-990-7062
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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 | 18004009A
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License Number State | IN
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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 | OPC5615
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License Number State | FL
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