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General NPI Number Information
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NPI Number | 1407874183
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Entity Type | Individual
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Provider Name | CARRIE S GAINES OD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 11188 TESSON FERRY RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6962
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Country | US
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Telephone | 314-842-5070
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Fax | 314-842-2316
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE C B 8096
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 314-842-5070
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Fax | 314-842-2316
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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 | T02777
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License Number State | MO
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