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General NPI Number Information
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NPI Number | 1386776714
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Entity Type | Individual
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Provider Name | SUSAN CERNEKA DREYER O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12536 OLIVE BOULEVARD SUITE B
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City | CREVE COEUR
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State | MO
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Zip | 63146
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Country | US
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Telephone | 314-878-1377
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Fax |
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Provider Business Mailing Address
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Address Line | 345 S GORE AVE
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City | WEBSTER GROVES
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State | MO
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Zip | 63119-3603
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Country | US
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Telephone | 314-962-8026
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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 | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | T02909
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License Number State | MO
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