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General NPI Number Information
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NPI Number | 1346622255
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Entity Type | Individual
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Provider Name | LAKSIRI F DE MEL O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 4528 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85018-7610
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Country | US
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Telephone | 602-273-1980
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Fax |
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Provider Business Mailing Address
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Address Line | 7316 N 23RD ST
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City | PHOENIX
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State | AZ
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Zip | 85020-4715
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Country | US
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Telephone | 480-703-2054
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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 | 2053
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License Number State | AZ
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