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General NPI Number Information
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NPI Number | 1386879237
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Entity Type | Organization
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Legal Business Name | JAMES GREMO OD
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 6023 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5116
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Country | US
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Telephone | 773-237-5779
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Fax |
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Provider Business Mailing Address
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Address Line | 6023 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5116
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Country | US
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Telephone | 773-237-5779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES B. GREMO
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Credential |
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Telephone | 773-237-5779
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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 | 0465905
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License Number State | IL
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