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General NPI Number Information
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NPI Number | 1356393623
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Entity Type | Individual
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Provider Name | DAVID J SLAGOWSKI O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 3499 E FAIRVIEW AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-5848
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Country | US
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Telephone | 208-884-1362
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 PRIMROSE LN
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City | FOND DU LAC
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State | WI
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Zip | 54935-1879
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Country | US
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Telephone | 208-631-8529
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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 | 3442-35
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License Number State | WI
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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 | ODP-1006
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License Number State | ID
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